Organization
PEDIATRICS IN BREVARD, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA LOISELLE (CREDENTIALING COORDINATOR)
(321) 435-9800
Entity
Organization
Contact information
Practice address
8057 SPYGLASS HILL RD STE 102, MELBOURNE, FL 32940-8565
(321) 435-9800
(321) 435-9803
Mailing address
134 S WOODS DR, ROCKLEDGE, FL 32955-3262
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253255703
—
FL
Enumeration date
11/02/2005
Last updated
10/04/2022
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