Provider Demographics
NPI:1003504739
Name:HOUSTON, MELVENIA
Entity Type:Individual
Prefix:
First Name:MELVENIA
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N FLORIDA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-1668
Mailing Address - Country:US
Mailing Address - Phone:352-419-5557
Mailing Address - Fax:
Practice Address - Street 1:111 N FLORIDA AVE STE B
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-1668
Practice Address - Country:US
Practice Address - Phone:352-419-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier