Basic Information
Provider Information
NPI: 1255352779
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESTES
FirstName: MELISA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4215 BURNS ROAD
Address2: SUITE 200
City: PALM BEACH GARDENS
State: FL
PostalCode: 334104625
CountryCode: US
TelephoneNumber: 5616947776
FaxNumber: 5616943099
Practice Location
Address1: 4215 BURNS ROAD
Address2: SUITE 100
City: PALM BEACH GARDENS
State: FL
PostalCode: 334104627
CountryCode: US
TelephoneNumber: 5616947776
FaxNumber: 5616943099
Other Information
ProviderEnumerationDate: 07/21/2006
LastUpdateDate: 03/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000XME0077605FLY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


Home