Healthcare Provider Details

I. General information

NPI: 1336801588
Provider Name (Legal Business Name): CHRISTIANE DE MELO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 N ANDREWS AVENUE EXT
POMPANO BEACH FL
33064-2067
US

IV. Provider business mailing address

1731 ROYAL GROVE WAY
WESTON FL
33327-1603
US

V. Phone/Fax

Practice location:
  • Phone: 954-225-3435
  • Fax:
Mailing address:
  • Phone: 516-445-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9114854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: