Provider Demographics
NPI:1689113185
Name:AUTRY, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:AUTRY
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 1:3709 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-8739
Mailing Address - Country:US
Mailing Address - Phone:321-375-9236
Mailing Address - Fax:321-256-5480
Practice Address - Street 1:3709 WARWICK DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-8739
Practice Address - Country:US
Practice Address - Phone:321-375-9236
Practice Address - Fax:321-256-5480
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst