Healthcare Provider Details

I. General information

NPI: 1669307476
Provider Name (Legal Business Name): KIRSTY MENDOZA BS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTY COKER

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 ROBERT J CONLAN BLVD NE
PALM BAY FL
32905-3502
US

IV. Provider business mailing address

3107 VASSAR ST
MELBOURNE FL
32901-7741
US

V. Phone/Fax

Practice location:
  • Phone: 321-479-4083
  • Fax: 321-294-5036
Mailing address:
  • Phone: 615-689-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: