Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101264446 | VA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME139719 | FL |
NPI | 1770927642 |
---|---|
Provider Name | Melyssa Kate Hancock |
First Address | Boca Raton, FL 33487-5713 |
Second Address | Boca Raton, FL 33487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 26/08/2019 |