Provider Demographics
NPI:1447206982
Name:MELISSA C VERDE DPM PA
Entity Type:Organization
Organization Name:MELISSA C VERDE DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VERDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-332-6700
Mailing Address - Street 1:1385 W STATE ROAD 434
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6871
Mailing Address - Country:US
Mailing Address - Phone:407-332-6700
Mailing Address - Fax:407-332-6226
Practice Address - Street 1:1385 W STATE ROAD 434
Practice Address - Street 2:SUITE 103
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6871
Practice Address - Country:US
Practice Address - Phone:407-332-6700
Practice Address - Fax:407-332-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2986213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5619650001Medicare NSC
FLU93023Medicare UPIN
FL65778YMedicare PIN