Provider Demographics
NPI:1760093991
Name:MELGAREJO, ILANA S (MA)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:S
Last Name:MELGAREJO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1976 NW 2ND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-4130
Mailing Address - Country:US
Mailing Address - Phone:352-448-9772
Mailing Address - Fax:
Practice Address - Street 1:1976 NW 2ND ST APT 2
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-4130
Practice Address - Country:US
Practice Address - Phone:352-448-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA84481225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist