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General NPI Number Information
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NPI Number | 1750923272
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Entity Type | Individual
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Provider Name | SHAWNA NICOLE MELVILLE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 4729 US HIGHWAY 98 S STE 201
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City | LAKELAND
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State | FL
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Zip | 33812-4336
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Country | US
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Telephone | 863-646-9663
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Fax | 863-364-6966
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Provider Business Mailing Address
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Address Line | 6675 WESTWOOD BLVD STE 475
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City | ORLANDO
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State | FL
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Zip | 32821-6027
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Country | US
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Telephone | 407-845-0330
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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 |
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License Number State |
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