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General NPI Number Information
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NPI Number | 1104064864
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Entity Type | Individual
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Provider Name | MELINDA LEE GAITANIS MA55295
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Gender | Female
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 490 E HATHAWAY AVE
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City | BRONSON
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State | FL
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Zip | 32621-6736
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Country | US
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Telephone | 352-486-6899
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Fax | 352-486-2974
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Provider Business Mailing Address
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Address Line | 491 N HATHAWAY AVE
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City | BRONSON
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State | FL
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Zip | 32621-6122
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Country | US
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Telephone | 352-281-9651
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Fax | 352-486-2974
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA55295
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License Number State | FL
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