Provider Demographics
NPI:1629769997
Name:ANTOINE, MELISSA SHINELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SHINELLE
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 CENTERVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9663
Mailing Address - Country:US
Mailing Address - Phone:757-770-6265
Mailing Address - Fax:
Practice Address - Street 1:651 W WARREN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4036
Practice Address - Country:US
Practice Address - Phone:321-999-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5255728164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse