| Melbourne Medpsych Pllc | |
|
1915 Oak Street Melbourne FL 32901 | |
| (540) 447-0134 | |
| (540) 932-7611 |
| Full Name | Melbourne Medpsych Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 1915 Oak Street, Melbourne, Florida |
| Authorized Official Name and Position | Gerald R Showalter (MBR) |
| Authorized Official Contact | 5404470134 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Melbourne Medpsych Pllc 406 Avenue B Melbourne Beach FL 32951-2215 Ph: (540) 447-0134 | Melbourne Medpsych Pllc 1915 Oak Street Melbourne FL 32901 Ph: (540) 447-0134 |
| NPI Number | 1346977311 |
|---|---|
| Provider Enumeration Date | 08/01/2022 |
| Last Update Date | 09/13/2022 |
| Certification Date | 09/13/2022 |
| Medicare PECOS PAC ID | 8022491356 |
|---|---|
| Medicare Enrollment ID | O20230123001438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346977311 | NPI | - | NPPES |
| PY10639 | Other | FL | FLORIDA BOARD OF PSYCHOLOGY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Gerald Ray Showalter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609847136 PECOS PAC ID: 9830387331 Enrollment ID: I20230123001655 |
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