MEDICARE: DR. MELISSA DEGESO PSY.D.

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	103TC0700X	Clinical Psychologist	PY9134	FL

General Provider Information

NPI Number	:	1154723351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA DEGESO PSY.D.

Provider Business Mailing Address
First Line	:	4100 W KENNEDY BLVD STE 214
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2244
Country	:	US
Telephone Number	:	813-375-2955
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 W KENNEDY BLVD STE 214
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2244
Country	:	US
Telephone Number	:	813-375-2955
Fax Number	:

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	05/08/2018

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