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General NPI Number Information
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NPI Number | 1326412404
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Entity Type | Individual
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Provider Name | MELISSA MARIA SANTIAGO PSY.D
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Gender | Female
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 6625 MIAMI LAKES DR STE 323
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2702
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Country | US
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Telephone | 305-998-9806
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Fax |
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Provider Business Mailing Address
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Address Line | 6625 MIAMI LAKES DR STE 323
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2702
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Country | US
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Telephone | 305-318-8255
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9429
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License Number State | FL
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