Healthcare Provider Details

I. General information

NPI: 1861636649
Provider Name (Legal Business Name): MELODIE J MOPE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 WINTER GARDEN VINELAND RD
WINDERMERE FL
34786-6098
US

IV. Provider business mailing address

5151 WINTER GARDEN VINELAND RD
WINDERMERE FL
34786-6098
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-3070
  • Fax: 407-636-7802
Mailing address:
  • Phone: 407-635-3070
  • Fax: 407-636-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME110713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: