Individual
MRS. MELISSA RAE PELOSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9035 PINES BLVD, PEMBROKE PINES, FL 33024
(954) 378-0333
Mailing address
215 SE 8TH AVE APT 680, FORT LAUDERDALE, FL 33301-3885
(561) 251-7610
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9109769
FL
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881148419
NPI
FL
Enumeration date
08/11/2016
Last updated
05/12/2020
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