Provider Demographics
NPI:1952955734
Name:SANTIAGO, MELISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 FORTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4428
Mailing Address - Country:US
Mailing Address - Phone:407-943-8600
Mailing Address - Fax:407-932-5150
Practice Address - Street 1:109 N DOVERPLUM AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3309
Practice Address - Country:US
Practice Address - Phone:407-943-8600
Practice Address - Fax:833-464-3641
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11848103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist