Provider Demographics
NPI:1750643276
Name:FEDORKO, MELINDA (MA, LMFT, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:FEDORKO
Suffix:
Gender:F
Credentials:MA, LMFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 SW 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4617
Mailing Address - Country:US
Mailing Address - Phone:305-255-8648
Mailing Address - Fax:305-355-8648
Practice Address - Street 1:12120 SW 109TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4617
Practice Address - Country:US
Practice Address - Phone:305-255-8648
Practice Address - Fax:305-355-8648
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT432106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist