Provider Demographics
NPI:1609651124
Name:GRIFFIS, MELITA FELISA
Entity Type:Individual
Prefix:
First Name:MELITA
Middle Name:FELISA
Last Name:GRIFFIS
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 1:23 RYBAR LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 BROCK RD
Practice Address - Street 2:
Practice Address - City:FLORAHOME
Practice Address - State:FL
Practice Address - Zip Code:32140-2401
Practice Address - Country:US
Practice Address - Phone:990-453-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator