Provider Demographics
NPI:1962917914
Name:MELVIN, AMOS L SR (HIS)
Entity type:Individual
Prefix:
First Name:AMOS
Middle Name:L
Last Name:MELVIN
Suffix:SR
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 COUNTY ROAD 220 STE 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4374
Mailing Address - Country:US
Mailing Address - Phone:904-302-0034
Mailing Address - Fax:
Practice Address - Street 1:3180 COUNTY ROAD 220 STE 2
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4374
Practice Address - Country:US
Practice Address - Phone:904-302-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist