MEDICARE: KALEY MELVILLE

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	101YM0800X	Mental Health Counselor	MT5334	FL

General Provider Information

NPI Number	:	1275323453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALEY MELVILLE

Provider Business Mailing Address
First Line	:	509 LIVE OAK ST OFC 1
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32132-1553
Country	:	US
Telephone Number	:	386-222-3011
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 LIVE OAK ST OFC 1
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32132-1553
Country	:	US
Telephone Number	:	386-222-3011
Fax Number	:

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

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	02/17/2026

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Directions to “ KALEY MELVILLE ” Practice Location

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