Provider Demographics
NPI:1609202050
Name:MANUEL MELENDEZ MD PA
Entity Type:Organization
Organization Name:MANUEL MELENDEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-477-4431
Mailing Address - Street 1:826 MEDINA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2418
Mailing Address - Country:US
Mailing Address - Phone:786-477-4431
Mailing Address - Fax:786-477-4377
Practice Address - Street 1:10250 SW 56TH ST STE A102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7064
Practice Address - Country:US
Practice Address - Phone:786-477-4431
Practice Address - Fax:786-477-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1026262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHS308AOther(PTAN ) MEDICARE PROVIDER TRANSACTION NUMBER
FL001349400Medicaid