Provider Demographics
NPI:1376594788
Name:BLOUNT, MELISSA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:S
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 LAKE ELLENOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5792
Mailing Address - Country:US
Mailing Address - Phone:407-992-0984
Mailing Address - Fax:
Practice Address - Street 1:7001 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5792
Practice Address - Country:US
Practice Address - Phone:407-992-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0068162207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261237200Medicaid
FL65535OtherCLIA #
FLG12294Medicare UPIN
CTC01407Medicare PIN
FL65535OtherCLIA #