Provider Demographics
NPI:1013210772
Name:MELENDEZ, IDALEE (PSY D)
Entity Type:Individual
Prefix:
First Name:IDALEE
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 ANDOVER CAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-2704
Mailing Address - Country:US
Mailing Address - Phone:407-346-8182
Mailing Address - Fax:
Practice Address - Street 1:4011 ANDOVER CAY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-2704
Practice Address - Country:US
Practice Address - Phone:407-346-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist