Provider Demographics
NPI:1902284177
Name:HOLT, MELIA HERNANDEZ (MD)
Entity type:Individual
Prefix:
First Name:MELIA
Middle Name:HERNANDEZ
Last Name:HOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELIA
Other - Middle Name:DOROTHY
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:515 W STATE ROAD 434 STE 210
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5162
Mailing Address - Country:US
Mailing Address - Phone:407-332-8080
Mailing Address - Fax:407-260-0602
Practice Address - Street 1:515 W STATE ROAD 434 STE 210
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5162
Practice Address - Country:US
Practice Address - Phone:407-332-8080
Practice Address - Fax:407-260-0602
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME139164207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty