Provider Demographics
NPI:1679308100
Name:SHIRAZI, MELISSA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SHIRAZI
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:ANCONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2903 CENTRUM PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7355
Mailing Address - Country:US
Mailing Address - Phone:321-831-6232
Mailing Address - Fax:
Practice Address - Street 1:2903 CENTRUM PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7355
Practice Address - Country:US
Practice Address - Phone:321-831-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9561021163W00000X
FLL311641174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No163W00000XNursing Service ProvidersRegistered Nurse