Provider Demographics
NPI:1336937192
Name:MELENDEZ THOMAS, LUISANA DANIELA
Entity type:Individual
Prefix:
First Name:LUISANA
Middle Name:DANIELA
Last Name:MELENDEZ THOMAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 METRO PKWY APT 6306
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-7923
Mailing Address - Country:US
Mailing Address - Phone:239-788-7402
Mailing Address - Fax:
Practice Address - Street 1:3747 METRO PKWY APT 6306
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-7923
Practice Address - Country:US
Practice Address - Phone:239-788-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician