Melinda Lee Gaitanis, MA55295
Individual provider Active NPI Specialist · Bronson, FL
NPI 1104064864 · NPPES record last updated Feb 3, 2009
Key facts
- NPI
- 1104064864
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- MA55295 (FL)
- Practice address
- 490 E Hathaway Ave
Bronson, FL 32621-6736 - Phone
- (352) 486-6899
- Fax
- (352) 486-2974
- NPI assigned
- Feb 3, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA55295 | FL | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shear Expressions | Specialist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA55295 | FL | Yes |
Addresses
Primary practice location
490 E Hathaway Ave
Bronson, FL 32621-6736
Mailing address
491 N Hathaway Ave
Bronson, FL 32621-6122
Phone (352) 281-9651
Other providers in Bronson, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.