Provider Demographics
NPI:1780965442
Name:MELENDEZ, JENNIFER MARY
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:MELENDEZ
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 1:4120 CHARDONNAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5131
Mailing Address - Country:US
Mailing Address - Phone:954-651-0414
Mailing Address - Fax:
Practice Address - Street 1:1333 GATEWAY DR STE 1014
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2647
Practice Address - Country:US
Practice Address - Phone:561-994-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 5528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist