Provider Demographics
NPI:1306515598
Name:MORENO, MELODIE LEE (ERYT-500)
Entity type:Individual
Prefix:MS
First Name:MELODIE
Middle Name:LEE
Last Name:MORENO
Suffix:
Gender:F
Credentials:ERYT-500
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3530
Mailing Address - Country:US
Mailing Address - Phone:727-422-3954
Mailing Address - Fax:
Practice Address - Street 1:3460 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3530
Practice Address - Country:US
Practice Address - Phone:727-422-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist