Provider Demographics
NPI:1972376218
Name:MENDOZA BERRIOS, MELANIE MARIE (BA)
Entity type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:MARIE
Last Name:MENDOZA BERRIOS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5969 LEE VISTA BLVD APT 105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1522
Mailing Address - Country:US
Mailing Address - Phone:787-988-0130
Mailing Address - Fax:
Practice Address - Street 1:222 BROADWAY UNIT 211
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5760
Practice Address - Country:US
Practice Address - Phone:407-329-3464
Practice Address - Fax:407-386-3344
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation