MEDICARE: MELISSA DOYLE PA-C

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	363A00000X	Physician Assistant	PA9110582	FL

General Provider Information

NPI Number	:	1548771868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DOYLE PA-C

Provider Business Mailing Address
First Line	:	110 N FEDERAL HWY APT 511
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-1182
Country	:	US
Telephone Number	:	786-219-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 NW 10TH AVE STE 101
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-1344
Country	:	US
Telephone Number	:	561-391-2708
Fax Number	:

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

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	10/25/2019

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