Provider Demographics
NPI:1588036784
Name:MELENDEZ, JESSICA D
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 PERTH PL
Mailing Address - Street 2:104
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3343
Mailing Address - Country:US
Mailing Address - Phone:407-785-7940
Mailing Address - Fax:
Practice Address - Street 1:880 PERTH PL
Practice Address - Street 2:104
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3343
Practice Address - Country:US
Practice Address - Phone:407-785-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherINSIGHT BEHAVIORAL HEALTH SPECIALISTS