Basic Information
| Provider Information | |||||||||
| NPI: | 1497756878 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELIDONA | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | JAMES | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 LAKE SUMTER LNDG | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321622699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526748905 | ||||||||
| FaxNumber: | 3526748919 | ||||||||
| Practice Location | |||||||||
| Address1: | 1575 SANTA BARBARA BLVD | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321596820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526741740 | ||||||||
| FaxNumber: | 3526748940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0S008145-L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS13041 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 468311 | 01 | PA | BC/BS | OTHER | 203752 | 01 | PA | UPMC | OTHER | 0014301690009 | 05 | PA | MEDICAID | 1027790 | 01 | PA | GATEWAY | OTHER |