Provider Demographics
NPI:1699252205
Name:MELENDEZ, ELIANA MARIA (DC)
Entity type:Individual
Prefix:
First Name:ELIANA
Middle Name:MARIA
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N VILLA SAN MARCO DR UNIT 306
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5194
Mailing Address - Country:US
Mailing Address - Phone:787-624-2176
Mailing Address - Fax:
Practice Address - Street 1:305 N VILLA SAN MARCO DR UNIT 306
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5194
Practice Address - Country:US
Practice Address - Phone:787-624-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor