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NPI Code Detail

MEDICARE: MELISSA SOSA GRANDE

MEDICARE: MELISSA SOSA GRANDE
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
1106S00000XBehavior TechnicianFL

General Provider Information

NPI Number : 1679114185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA SOSA GRANDE
Provider Business Mailing Address
First Line : 9523 S HOLLYBROOK LAKE DR APT 308
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33025-1698
Country : US
Telephone Number : 954-865-2853
Fax Number :
Provider Business Practice Location Address
First Line : 9523 S HOLLYBROOK LAKE DR APT 308
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33025-1698
Country : US
Telephone Number : 954-865-2853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2019
Last Update Date : 10/06/2019

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Directions to “ MELISSA SOSA GRANDE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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