Provider Demographics
NPI:1841285723
Name:GREENFIELD, MELINDA FAYE (DO)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:FAYE
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7176
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:520 A1A N STE 203
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-2260
Practice Address - Country:US
Practice Address - Phone:904-567-3291
Practice Address - Fax:904-834-4278
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049451207N00000X
FLOS13654207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00892471AMedicaid
FL020051200Medicaid