=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528709698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA FERNANDEZ-BRITTO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2022
-----------------------------------------------------
Last Update Date | 10/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8423 NW 138TH TER APT 2806
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-6592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-262-7866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8423 NW 138TH TER APT 2806
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-6592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-262-7866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT22999
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------