Organization
PEDIATRICS IN BREVARD, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA LOISELLE (CREDENTIALING COORDINATOR)
(321) 877-4438
Entity
Organization
Contact information
Practice address
1755 W HIBISCUS BLVD, MELBOURNE, FL 32901-2616
(321) 724-5437
(321) 724-5570
Mailing address
1755 W HIBISCUS BLVD, MELBOURNE, FL 32901-2616
(321) 724-5437
(321) 724-5570
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253255701
—
FL
Enumeration date
11/02/2005
Last updated
07/13/2021
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