Provider Demographics
NPI:1124017017
Name:MAISENBACHER, MELISSA KIMBERLY (MS,CGC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KIMBERLY
Last Name:MAISENBACHER
Suffix:
Gender:F
Credentials:MS,CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8634 SW 66TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5666
Mailing Address - Country:US
Mailing Address - Phone:352-376-8897
Mailing Address - Fax:352-392-3051
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:UF PEDIATRIC GENETICS
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-4104
Practice Address - Fax:352-392-3051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS