Provider Demographics
NPI:1578890422
Name:BARBOSA, MALISSA MICHELE (DO)
Entity Type:Individual
Prefix:DR
First Name:MALISSA
Middle Name:MICHELE
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 BARKING DEER CV
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 N ALAFAYA TRL STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4732
Practice Address - Country:US
Practice Address - Phone:717-653-1467
Practice Address - Fax:407-914-2459
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO2948207Q00000X, 207QA0401X
PAOS016808207QA0401X, 207QB0002X
VA0102206962207QA0401X, 207QB0002X
FLOS14974207QB0002X, 207QA0401X
PAOT013207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine