Provider Demographics
NPI:1144518234
Name:MELCON, CAROLINA CELESTE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:CELESTE
Last Name:MELCON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:CELESTE
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:335 S KROME AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034
Mailing Address - Country:US
Mailing Address - Phone:305-242-8122
Mailing Address - Fax:305-242-8837
Practice Address - Street 1:335 S KROME AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034
Practice Address - Country:US
Practice Address - Phone:305-242-8122
Practice Address - Fax:305-242-8837
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010054900Medicaid