Provider Demographics
NPI:1992815203
Name:MELENDEZ, MANUEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 MEDINA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2418
Mailing Address - Country:US
Mailing Address - Phone:786-477-4431
Mailing Address - Fax:786-477-4377
Practice Address - Street 1:10250 SW 56TH ST STE A102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165
Practice Address - Country:US
Practice Address - Phone:786-477-4431
Practice Address - Fax:786-477-4377
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1026262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCP025AOtherMEDICARE PTAN
FLME102626OtherLICENSE
FL001349400Medicaid
FLCP025AOtherMEDICARE PTAN