Provider Demographics
NPI:1396210258
Name:MELENDEZ, DUREIDA ELID
Entity Type:Individual
Prefix:
First Name:DUREIDA
Middle Name:ELID
Last Name:MELENDEZ
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 1:5530 METROWEST BLVD APT 309
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2443
Mailing Address - Country:US
Mailing Address - Phone:939-277-8207
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST STE 278
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4673
Practice Address - Country:US
Practice Address - Phone:321-900-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty