Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | ME91155 | FL |
NPI | 1689659641 |
---|---|
Provider Name | Dr. Melissa Lynn Crenshaw |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2707527 00 | (05) | FL |
I21115 | (02) | FL |