Healthcare Provider Details

I. General information

NPI: 1184627374
Provider Name (Legal Business Name): MELISSA C KIRBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 LAKE UNDERHILL RD STE 215
ORLANDO FL
32828-4511
US

IV. Provider business mailing address

12301 LAKE UNDERHILL RD STE 215
ORLANDO FL
32828-4511
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-0692
  • Fax: 321-235-0694
Mailing address:
  • Phone: 321-235-0692
  • Fax: 321-235-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME90382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: