Provider Demographics
NPI:1720289622
Name:DUCOTE, MELISSA J (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J
Last Name:DUCOTE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 SW GRAPEVINE LN
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3255
Mailing Address - Country:US
Mailing Address - Phone:772-219-9936
Mailing Address - Fax:
Practice Address - Street 1:1807 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-7204
Practice Address - Country:US
Practice Address - Phone:772-286-6260
Practice Address - Fax:772-286-6912
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0013879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist