Provider Demographics
NPI:1225112634
Name:IGLESIAS, MELISSA (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11641 KEW GARDENS AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2846
Mailing Address - Country:US
Mailing Address - Phone:561-331-3833
Mailing Address - Fax:
Practice Address - Street 1:11641 KEW GARDENS AVE STE 209
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2846
Practice Address - Country:US
Practice Address - Phone:561-331-3833
Practice Address - Fax:561-331-3893
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12688207WX0107X, 207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102436007Medicaid
FL012387200Medicaid
PA178404D1PMedicare PIN