Provider Demographics
NPI:1689165573
Name:MENDOZA, MELANIE C (AP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:C
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 JACKSON CT
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3225
Mailing Address - Country:US
Mailing Address - Phone:407-275-5184
Mailing Address - Fax:
Practice Address - Street 1:1804 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1854
Practice Address - Country:US
Practice Address - Phone:407-965-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2390171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist