MEDICARE: MELISSA WALLS MA

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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst	1-18-34001	FL

General Provider Information

NPI Number	:	1841609138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WALLS MA

Provider Business Mailing Address
First Line	:	5739 BYRON ANTHONY PL STE 1001
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-8638
Country	:	US
Telephone Number	:	321-483-7880
Fax Number	:

Provider Business Practice Location Address
First Line	:	5739 BYRON ANTHONY PL STE 1001
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-8638
Country	:	US
Telephone Number	:	321-483-7880
Fax Number	:

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

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	01/08/2025

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Directions to “ MELISSA WALLS MA” Practice Location

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