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NPI Code Detail

MEDICARE: CASSIDY MELANSON CTRI

MEDICARE: CASSIDY MELANSON CTRI
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
1171W00000XContractorFL

General Provider Information

NPI Number : 1194682690
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY MELANSON CTRI
Provider Business Mailing Address
First Line : 1219 DUNN AVE
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-2405
Country : US
Telephone Number : 386-944-7804
Fax Number :
Provider Business Practice Location Address
First Line : 3804 PIONEER TRL
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-8784
Country : US
Telephone Number : 386-262-8538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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Directions to “ CASSIDY MELANSON CTRI” Practice Location

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