Provider Demographics
NPI:1851678106
Name:BROWN, MELYNDA (PA)
Entity Type:Individual
Prefix:
First Name:MELYNDA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 BARKLEY CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7531
Mailing Address - Country:US
Mailing Address - Phone:239-333-1177
Mailing Address - Fax:239-333-1169
Practice Address - Street 1:3210 CLEVELAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7182
Practice Address - Country:US
Practice Address - Phone:239-936-6778
Practice Address - Fax:239-936-1246
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106141363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGA343ZMedicare PIN
FL0626040002Medicare NSC