Provider Demographics
NPI:1821390584
Name:BURGOS-MARTIR, MELISSA A (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BURGOS-MARTIR
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 1:1344 S APOLLO BLVD STE 200B
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3183
Mailing Address - Country:US
Mailing Address - Phone:321-499-4646
Mailing Address - Fax:321-270-9449
Practice Address - Street 1:1344 S APOLLO BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3183
Practice Address - Country:US
Practice Address - Phone:321-499-4646
Practice Address - Fax:321-270-9449
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132811208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6459707OtherUHC
FL2YU7CNOtherFLORIDA BLUE