Provider Demographics
NPI:1821411158
Name:MELENDEZ, WILFREDO (MS)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 FRENCH PLUM LN
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6333
Mailing Address - Country:US
Mailing Address - Phone:352-283-4139
Mailing Address - Fax:877-894-2840
Practice Address - Street 1:7515 SW 26TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9515
Practice Address - Country:US
Practice Address - Phone:352-283-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12952101YM0800X
FLIMH10481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health