Provider Demographics
NPI:1679118871
Name:FERNANDEZ MELENDEZ, ANA MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:MICHELLE
Last Name:FERNANDEZ MELENDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANA
Other - Middle Name:MICHELLE
Other - Last Name:FERNANDEZ MELENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:COND SANTA MARIA 139 CARR 177 APT 901
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5352
Mailing Address - Country:US
Mailing Address - Phone:787-410-9800
Mailing Address - Fax:
Practice Address - Street 1:4 PR-695
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-391-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6357103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6357OtherPROFESSIONAL LICENSED