Provider Demographics
NPI:1306385737
Name:GALAY FLORES, MELANIE JANICE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANICE
Last Name:GALAY FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 OAKFIELD DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-0802
Mailing Address - Country:US
Mailing Address - Phone:813-655-4166
Mailing Address - Fax:
Practice Address - Street 1:9051 FLORIDA MINING BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1240
Practice Address - Country:US
Practice Address - Phone:800-356-4049
Practice Address - Fax:941-485-0519
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 101Y00000X
FLRBT-20-142414106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134107113OtherFALLON
MA1134107113Medicaid
MA1134107113OtherMBHP
MA71756OtherTUFTS
MA997303OtherNETWORK HEALTH
MA042622756OtherCCA
MA1134107113OtherNHP
MA1134107113OtherBEACON
MA12529OtherHNE
MAY10086Medicare PIN