Provider Demographics
NPI:1689659641
Name:CRENSHAW, MELISSA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:601 5TH ST S
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-8491
Mailing Address - Fax:727-767-8270
Practice Address - Street 1:880 6TH ST S
Practice Address - Street 2:SUITE 240
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4827
Practice Address - Country:US
Practice Address - Phone:727-767-8491
Practice Address - Fax:727-767-8270
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME91155207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2707527 00Medicaid
FLI21115Medicare UPIN