Provider Demographics
NPI:1851525984
Name:MELENDEZ-DAVIDSON, JOSEPH WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:MELENDEZ-DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:MPG DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5581
Mailing Address - Fax:954-985-7081
Practice Address - Street 1:4651 SHERIDAN ST
Practice Address - Street 2:SUITE 350
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3457
Practice Address - Country:US
Practice Address - Phone:954-276-8559
Practice Address - Fax:954-966-9762
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120123208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012301300Medicaid
FLHV227YOtherMEDICARE PTAN