Provider Demographics
NPI:1245207463
Name:RIESS, MELISSA SIMMONS (AUD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SIMMONS
Last Name:RIESS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 LAKE BALDWIN LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6684
Mailing Address - Country:US
Mailing Address - Phone:407-898-2220
Mailing Address - Fax:
Practice Address - Street 1:1460 LAKE BALDWIN LN
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6684
Practice Address - Country:US
Practice Address - Phone:407-898-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1079237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS9268OtherBCBS OF FLORIDA
FL000200200Medicaid
FL000200200Medicaid