Provider Demographics
NPI:1487932455
Name:MELENDEZ-VEGA, ALEXIS MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:MARIE
Last Name:MELENDEZ-VEGA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 W 21ST CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2630
Mailing Address - Country:US
Mailing Address - Phone:305-776-8783
Mailing Address - Fax:
Practice Address - Street 1:5771 W 21ST CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2630
Practice Address - Country:US
Practice Address - Phone:305-776-8783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6539235Z00000X
FLSA14101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty