Provider Demographics
NPI:1578762969
Name:MELIAN, SANDOR (PA-C)
Entity Type:Individual
Prefix:
First Name:SANDOR
Middle Name:
Last Name:MELIAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W EAU GALLIE BLVD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4033
Mailing Address - Country:US
Mailing Address - Phone:321-500-4263
Mailing Address - Fax:888-782-9622
Practice Address - Street 1:2010 W EAU GALLIE BLVD UNIT 104
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4033
Practice Address - Country:US
Practice Address - Phone:321-500-4263
Practice Address - Fax:888-782-9622
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL # 9992255A2300X
FLPA9110860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer