Provider Demographics
NPI:1508255415
Name:MENA, MASSIEL R (MD,MBA,HC, TECH)
Entity Type:Individual
Prefix:
First Name:MASSIEL
Middle Name:R
Last Name:MENA
Suffix:
Gender:F
Credentials:MD,MBA,HC, TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SILVER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-9408
Mailing Address - Country:US
Mailing Address - Phone:407-552-2677
Mailing Address - Fax:
Practice Address - Street 1:1523 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1604
Practice Address - Country:US
Practice Address - Phone:407-891-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1100X
ZZ480-05208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic