Individual provider Active NPI

Noemi Melendez-Kaylor, PA

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1154340115
Registry record updated Sep 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9103332 Issued in FL
Practice address
3638 Madaca LN
Tampa, FL 33618-2057
Phone
(813) 968-6610
Fax
(813) 264-1669
NPI assigned
Jul 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9103332 FL Primary

Addresses

Primary practice location

3638 Madaca LN
Tampa, FL 33618-2057

Mailing address

4033 Tampa Rd Ste 101
Attn: Credentialing
Oldsmar, FL 34677-3224
Phone (813) 854-2003

Other identifiers 1

IdentifierTypeStateIssuer
292326200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9103332FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Health Care Alliance, PA Past Accepting new patients
Pediatric Health Care Alliance, PA PastSince Aug 28, 2021 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1154340115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4033 TAMPA RD STE 101",
            "address_2": "ATTN: CREDENTIALING",
            "city": "OLDSMAR",
            "state": "FL",
            "postal_code": "346773224",
            "telephone_number": "813-854-2003",
            "fax_number": "813-855-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3638 MADACA LN",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182057",
            "telephone_number": "813-968-6610",
            "fax_number": "813-264-1669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELENDEZ-KAYLOR",
        "first_name": "NOEMI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292326200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.