Provider Demographics
NPI:1023831989
Name:CERVANTES, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CERVANTES
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 1:233 W AVENUE A STE C
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3092
Mailing Address - Country:US
Mailing Address - Phone:561-253-3680
Mailing Address - Fax:561-253-3680
Practice Address - Street 1:233 W AVENUE A STE C
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3092
Practice Address - Country:US
Practice Address - Phone:561-253-3680
Practice Address - Fax:561-253-3680
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator