Healthcare Provider Details

I. General information

NPI: 1215248034
Provider Name (Legal Business Name): MELANIE DIANE HAMMACK FRIEND AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 HIGHWAY 90 STE 350
PACE FL
32571-1098
US

IV. Provider business mailing address

580 HOWARD AVE
SOMERSET NJ
08873-1113
US

V. Phone/Fax

Practice location:
  • Phone: 850-889-4261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1618
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: