Provider Demographics
NPI:1114108669
Name:SOSA MELO, ANDREA MARCELA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARCELA
Last Name:SOSA MELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5605 NW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4000
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:786-618-5307
Practice Address - Street 1:4888 NW 183RD ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2939
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-623-9459
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113639207R00000X, 207RE0101X
RI13295207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016839400Medicaid