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General NPI Number Information
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NPI Number | 1710309364
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Entity Type | Individual
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Provider Name | MS. MELISSA WILKES
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Gender | Female
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 711 CLEVELAND AVE
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City | WILDWOOD
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State | FL
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Zip | 34785-3502
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Country | US
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Telephone | 352-399-6862
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Fax | 352-399-6863
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Provider Business Mailing Address
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Address Line | 711 CLEVELAND AVE
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City | WILDWOOD
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State | FL
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Zip | 34785-3502
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Country | US
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Telephone | 352-399-6862
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Fax | 352-399-6863
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9263
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License Number State | FL
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