Provider Demographics
NPI:1386229912
Name:JORDAN, MELANIE (MJ)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10611 CARIBBEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1360
Mailing Address - Country:US
Mailing Address - Phone:786-370-9180
Mailing Address - Fax:
Practice Address - Street 1:13301 SW 132ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6188
Practice Address - Country:US
Practice Address - Phone:786-713-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267084131Medicaid