Provider Demographics
NPI:1770637373
Name:HAYNES, MELANIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:R
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1548
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-1548
Mailing Address - Country:US
Mailing Address - Phone:727-545-3376
Mailing Address - Fax:727-545-5003
Practice Address - Street 1:9005 BELCHER RD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4423
Practice Address - Country:US
Practice Address - Phone:727-545-3376
Practice Address - Fax:727-545-5003
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48813207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9017600OtherCIGNA PROVIDER NUMBER
FL0004332698OtherAETNA PIN
FL12272XMedicare ID - Type UnspecifiedPROVIDER NUMBER
FLD98116Medicare UPIN