MEDICARE: MELISSA SERRANO

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	SA15302	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770860850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SERRANO

Provider Business Mailing Address
First Line	:	6136 NW KENDRA LN
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-4139
Country	:	US
Telephone Number	:	787-412-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 NW PRIMA VISTA BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-8731
Country	:	US
Telephone Number	:	772-249-0341
Fax Number	:	772-249-4642

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

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	11/29/2018

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Directions to “ MELISSA SERRANO ” Practice Location

Language	Start Address	Practice Location

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