Melanie Loretta Bradley, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS16693 Issued in FL

Practice address

101 Marketside Ave Ste 405
Ponte Vedra, FL 32081-1542

Phone

(904) 223-9100

NPI assigned

Mar 27, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Melanie Loretta Burnett Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Pediatrica Health of Florida, LLC

  • Pediatric Adolescent Medicine Physician
  • Jacksonville, FL
  • NPI 1316385164
  NPD (past)
• Pinnacles Peds Care, PA

  • Pediatrics Physician
  • Palm Coast, FL
  • NPI 1194033753
  NPD (past)
• West Point Optical Group

  • Optometrist
  • Ann Arbor, MI
  • NPI 1073983698
  NPD (past)

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1760913057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 ROYAL LAKE DR",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320810537",
            "telephone_number": "904-208-8724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MARKETSIDE AVE STE 405",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320811542",
            "telephone_number": "904-223-9100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Davis Blvd. Suite 308",
            "address_2": "University of South Florida, Morsani College of Medicin",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "33606",
            "country_code": "US",
            "telephone_number": "813-250-2506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MELANIE",
        "middle_name": "LORETTA",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-27",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS16693",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELANIE",
            "last_name": "BURNETT",
            "middle_name": "LORETTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bluebird Medical & Wellness Corp
• Bluebird Pediatrics
• Bluewater Wellness Center
• Jennifer Borgio, ATC
• William David Boyd, M.D.
• Meredith Johnston Brazell, D.O.
• Julie Bredt, ARNP-FNP
• Michele Brenneman, PH.D.
• Jeffrey Joseph Brimmer, D.P.M.
• Josephine Elizabeth Brooke, APRN

• Pediatrics Physician in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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.