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General NPI Number Information
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NPI Number | 1336801588
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Entity Type | Individual
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Provider Name | CHRISTIANE DE MELO PA
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Gender | Female
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 1644 W HILLSBORO BLVD
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-1657
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Country | US
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Telephone | 954-694-0741
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Fax |
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Provider Business Mailing Address
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Address Line | 1731 ROYAL GROVE WAY
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City | WESTON
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State | FL
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Zip | 33327-1603
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Country | US
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Telephone | 516-445-2935
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9114854
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License Number State | FL
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