Provider Demographics
NPI:1881938231
Name:PANCHULA, MELANIE (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PANCHULA
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:PICARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HOME HEALTH AIDE
Mailing Address - Street 1:1656 POLK ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5222
Mailing Address - Country:US
Mailing Address - Phone:954-598-4263
Mailing Address - Fax:
Practice Address - Street 1:1656 POLK ST
Practice Address - Street 2:UNIT 3
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-5222
Practice Address - Country:US
Practice Address - Phone:954-598-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health