Provider Demographics
NPI:1609640978
Name:GERCEK, MELIS EDA
Entity type:Individual
Prefix:MS
First Name:MELIS
Middle Name:EDA
Last Name:GERCEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14250 SW 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1691
Mailing Address - Country:US
Mailing Address - Phone:305-873-9039
Mailing Address - Fax:
Practice Address - Street 1:13300 SW 128TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5899
Practice Address - Country:US
Practice Address - Phone:786-250-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician