Provider Demographics
NPI:1619851904
Name:EGAN, MELISSA JUNE
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JUNE
Last Name:EGAN
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:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:FLORAL CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34436-0358
Mailing Address - Country:US
Mailing Address - Phone:352-942-8622
Mailing Address - Fax:
Practice Address - Street 1:5139 S BRIDGET PT
Practice Address - Street 2:
Practice Address - City:FLORAL CITY
Practice Address - State:FL
Practice Address - Zip Code:34436-2159
Practice Address - Country:US
Practice Address - Phone:342-952-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL25000339661342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company