Provider Demographics
NPI:1841453479
Name:VELOSA, MELODY MARTIN
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:MARTIN
Last Name:VELOSA
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 1:918 REED CANAL RD LOT 224
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3147
Mailing Address - Country:US
Mailing Address - Phone:386-852-5250
Mailing Address - Fax:
Practice Address - Street 1:918 REED CANAL RD LOT 224
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3147
Practice Address - Country:US
Practice Address - Phone:386-852-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist