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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
1018 FLORIDA AVE S STE A, ROCKLEDGE, FL 32955-2142
(321) 636-3066
(321) 636-2545
Mailing address
134 S WOODS DR, ROCKLEDGE, FL 32955-3262
(321) 636-3066
(321) 636-2545

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
253255700
FL
05
253255701
FL
05
253255705
FL
05
253555703
FL
Enumeration date
11/02/2005
Last updated
02/06/2025
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