Provider Demographics
NPI:1295703288
Name:DEAN, MELISSA (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 36TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4811
Mailing Address - Country:US
Mailing Address - Phone:772-567-1500
Mailing Address - Fax:772-567-1505
Practice Address - Street 1:1345 36TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4811
Practice Address - Country:US
Practice Address - Phone:772-567-1500
Practice Address - Fax:772-567-1505
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ313Medicare PIN
FLU3075BMedicare ID - Type UnspecifiedMEDICARE
FLQ25883Medicare UPIN