Provider Demographics
NPI:1538925219
Name:ROLLINS, MELISSA DIANNE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANNE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 SAGE BRUSH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32442-8906
Mailing Address - Country:US
Mailing Address - Phone:850-557-2137
Mailing Address - Fax:
Practice Address - Street 1:2137 SAGE BRUSH AVE
Practice Address - Street 2:
Practice Address - City:GRAND RIDGE
Practice Address - State:FL
Practice Address - Zip Code:32442-8906
Practice Address - Country:US
Practice Address - Phone:850-557-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services