MEDICARE: MISS MELISSA ANN WYNNE MMS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9109994	FL
2	363AS0400X	Surgical Physician Assistant	PA9109994	FL

General Provider Information

NPI Number	:	1003366592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELISSA ANN WYNNE MMS, PA-C

Provider Business Mailing Address
First Line	:	2310 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2314
Country	:	US
Telephone Number	:	786-496-9444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2314
Country	:	US
Telephone Number	:	786-496-9444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	02/03/2026

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