Provider Demographics
NPI:1073070439
Name:MELTON, JOY (MA, EDS)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6980
Mailing Address - Country:US
Mailing Address - Phone:772-925-9551
Mailing Address - Fax:
Practice Address - Street 1:106 PADDOCK ST
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-6980
Practice Address - Country:US
Practice Address - Phone:772-925-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No174H00000XOther Service ProvidersHealth Educator