Provider Demographics
NPI:1568470151
Name:MELMED, DANIEL (LMT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MELMED
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6847 W LISERON
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6475
Mailing Address - Country:US
Mailing Address - Phone:561-306-2324
Mailing Address - Fax:
Practice Address - Street 1:2787 E OAKLAND PARK BLVD
Practice Address - Street 2:STE 204
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1647
Practice Address - Country:US
Practice Address - Phone:954-496-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 44521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 44521OtherMASSAGE THERAPIST