Provider Demographics
NPI:1326412404
Name:SANTIAGO, MELISSA MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 MIAMI LAKES DR STE 323
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2702
Mailing Address - Country:US
Mailing Address - Phone:305-318-8255
Mailing Address - Fax:
Practice Address - Street 1:6625 MIAMI LAKES DR STE 323
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2702
Practice Address - Country:US
Practice Address - Phone:305-998-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9429103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical