Provider Demographics
NPI:1275939142
Name:MELVIN, AMOS JR (BC-HIS)
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:
Last Name:MELVIN
Suffix:JR
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CYPRESS POINT PKWY.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164
Mailing Address - Country:US
Mailing Address - Phone:386-283-4906
Mailing Address - Fax:
Practice Address - Street 1:145 CYPRESS POINT PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8426
Practice Address - Country:US
Practice Address - Phone:386-283-4906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3546237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist