Provider Demographics
NPI:1306291067
Name:MELINA SCALLY PSYD LLC
Entity type:Organization
Organization Name:MELINA SCALLY PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-432-8743
Mailing Address - Street 1:1815 TWILIGHT TIDES ST
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-5795
Mailing Address - Country:US
Mailing Address - Phone:813-360-0741
Mailing Address - Fax:813-241-2910
Practice Address - Street 1:1506 N 15TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-5044
Practice Address - Country:US
Practice Address - Phone:813-360-0741
Practice Address - Fax:813-241-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty