Provider Demographics
NPI:1013240654
Name:ATWATER, MELISSA JEAN
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEAN
Last Name:ATWATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 HERNANDO PL
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-8069
Mailing Address - Country:US
Mailing Address - Phone:352-432-3809
Mailing Address - Fax:
Practice Address - Street 1:119 BIG BEND WAY
Practice Address - Street 2:
Practice Address - City:WARNERS
Practice Address - State:NY
Practice Address - Zip Code:13164-3702
Practice Address - Country:US
Practice Address - Phone:352-432-3998
Practice Address - Fax:352-432-3999
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1212916182174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist