Provider Demographics
NPI:1861633463
Name:MALLETTE, CLAUDIA R (DPM)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:R
Last Name:MALLETTE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 S HARBOR CITY BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1389
Mailing Address - Country:US
Mailing Address - Phone:321-728-0117
Mailing Address - Fax:321-728-0151
Practice Address - Street 1:200 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1384
Practice Address - Country:US
Practice Address - Phone:321-728-0117
Practice Address - Fax:321-728-0151
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO 2629213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU69335Medicare UPIN
FL65505ZMedicare PIN