Healthcare Provider Details

I. General information

NPI: 1770143729
Provider Name (Legal Business Name): MRS. MELISSA MICHELLE PANTELIODIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MICHELLE SWERTFEGER

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 66TH ST N
PINELLAS PARK FL
33781-5025
US

IV. Provider business mailing address

9719 HIDDEN OAKS CIR
TAMPA FL
33612-7815
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-8100
  • Fax:
Mailing address:
  • Phone: 727-599-9823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberAPRN11002707
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: