Provider Demographics
NPI:1316590318
Name:HUMMEL, MELANIE (EDS)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 W IRLO BRONSON MEMORIAL HWY # 200
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1764
Mailing Address - Country:US
Mailing Address - Phone:304-280-6249
Mailing Address - Fax:
Practice Address - Street 1:7664 COMROW ST UNIT 205
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-2170
Practice Address - Country:US
Practice Address - Phone:304-280-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1302988103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool