Provider Demographics
NPI:1992257091
Name:EWING, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 140TH AVE N
Mailing Address - Street 2:SUITE 313
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3834
Mailing Address - Country:US
Mailing Address - Phone:727-744-3629
Mailing Address - Fax:727-303-3952
Practice Address - Street 1:4707 140TH AVE N
Practice Address - Street 2:SUITE 313
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3834
Practice Address - Country:US
Practice Address - Phone:727-744-3629
Practice Address - Fax:727-303-3952
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health