MEDICARE: MELISSA HERNANDEZ FERNANDEZ

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1063225159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA HERNANDEZ FERNANDEZ

Provider Business Mailing Address
First Line	:	518 SW 4TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 SW 4TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1917
Country	:	US
Telephone Number	:	239-220-7731
Fax Number	:

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

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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Directions to “ MELISSA HERNANDEZ FERNANDEZ ” Practice Location

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