MEDICARE: MELANIE LYNN SANTIAGO

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	024583	NY
2	363A00000X	Physician Assistant	PA9120223	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326519117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE LYNN SANTIAGO

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-9470
Fax Number	:	239-343-9498

Provider Business Practice Location Address
First Line	:	8960 COLONIAL CENTER DR STE 300
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7810
Country	:	US
Telephone Number	:	239-343-9470
Fax Number	:	239-343-9498

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

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	01/29/2026

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Directions to “ MELANIE LYNN SANTIAGO ” Practice Location

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