Provider Demographics
NPI:1730135104
Name:VERDE, MELISA C (DPM)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:C
Last Name:VERDE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1385 W STATE ROAD 434
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6871
Mailing Address - Country:US
Mailing Address - Phone:407-332-6700
Mailing Address - Fax:407-332-6266
Practice Address - Street 1:1385 W STATE ROAD 434
Practice Address - Street 2:SUITE 103
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6871
Practice Address - Country:US
Practice Address - Phone:407-332-6700
Practice Address - Fax:407-332-6266
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2986213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5619650001Medicare NSC
FL65778YMedicare PIN
FLU93023Medicare UPIN