MEDICARE: SHANNON CHRISTIE MELLONE M.S.

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	235Z00000X	Speech-Language Pathologist	SZ 7090	FL

General Provider Information

NPI Number	:	1750760377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON CHRISTIE MELLONE M.S.

Provider Business Mailing Address
First Line	:	179 CITY POINT RD
Second Line	:
City	:	COCOA
State	:	FL
Zip	:	32926-8745
Country	:	US
Telephone Number	:	321-544-6608
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 E OAKLAND AVE UNIT B
Second Line	:
City	:	OAKLAND
State	:	FL
Zip	:	34787-3070
Country	:	US
Telephone Number	:	407-654-5455
Fax Number	:

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

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	05/28/2015

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Directions to “ SHANNON CHRISTIE MELLONE M.S.” Practice Location

Language	Start Address	Practice Location

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