Provider Demographics
NPI:1821483942
Name:NICOLETTI, MELISSA SUSAN (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUSAN
Last Name:NICOLETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1222 S ORANGE AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1215
Mailing Address - Country:US
Mailing Address - Phone:321-841-3040
Mailing Address - Fax:321-841-3049
Practice Address - Street 1:1222 S ORANGE AVE FL 5
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1215
Practice Address - Country:US
Practice Address - Phone:321-841-3040
Practice Address - Fax:321-841-3049
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146004207Q00000X, 207QS0010X
HIMD-19703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111307700Medicaid