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General NPI Number Information
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NPI Number | 1770815755
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Entity Type | Individual
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Provider Name | MELISSA D WILKES
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Gender | Female
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 13838 TILDEN RD
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5318
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Country | US
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Telephone | 407-287-9113
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Fax |
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Provider Business Mailing Address
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Address Line | 25 W CRYSTAL LAKE ST STE 200
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City | ORLANDO
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State | FL
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Zip | 32806-4476
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Country | US
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Telephone | 407-254-2500
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Fax | 407-423-2789
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | AMD-1144
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119844
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License Number State | FL
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