MEDICARE: MELISSA D. FENTON, PA

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	MH8881	FL

General Provider Information

NPI Number	:	1629110226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA D. FENTON, PA

Provider Business Mailing Address
First Line	:	13500 SUTTON PARK DR S STE 203
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5291
Country	:	US
Telephone Number	:	904-992-9930
Fax Number	:

Provider Business Practice Location Address
First Line	:	13500 SUTTON PARK DR S STE 203
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5291
Country	:	US
Telephone Number	:	904-992-9930
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELISSA FENTON
Credential	:
Telephone Number	:	904-992-9930

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/22/2020

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