Provider Demographics
NPI:1043927288
Name:ROUSSEAU, MELISSA J (NP, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:J
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:NP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 E TREASURE DR APT 2H
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4307
Mailing Address - Country:US
Mailing Address - Phone:203-718-6739
Mailing Address - Fax:
Practice Address - Street 1:1065 NE 125TH ST STE 206
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5832
Practice Address - Country:US
Practice Address - Phone:305-891-0050
Practice Address - Fax:305-891-4228
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021822363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health