Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1013210772 |
---|---|
Provider Name | Idalee Melendez |
First Address | Orlando, FL 32825-2704 |
Second Address | Orlando, FL 32825-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2010 |
Last Update Date | 17/12/2010 |