Provider Demographics
NPI:1538804307
Name:MENDEZ, MELONIE (EDS)
Entity type:Individual
Prefix:
First Name:MELONIE
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 W MISSIONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2939
Mailing Address - Country:US
Mailing Address - Phone:954-408-2149
Mailing Address - Fax:
Practice Address - Street 1:2939 W MISSIONWOOD LN
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2939
Practice Address - Country:US
Practice Address - Phone:954-408-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1623103TB0200X, 103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSS1623OtherFL DOH - SCHOOL PSYCHOLOGY
FL103T00000XMedicaid