Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | UO2948 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS016808 | PA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | OS14974 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | UO2948 | FL |
N | 207R00000X | Internist | OT013207 | PA |
N | 111NI0900X | Internist | OT013207 | PA |
NPI | 1578890422 |
---|---|
Provider Name | Dr. Malissa Michele Barbosa |
First Address | Casselberry, FL 32707-5843 |
Second Address | Orlando, FL 32826-4732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2009 |
Last Update Date | 23/02/2018 |