Basic Information
| Provider Information | |||||||||
| NPI: | 1508439233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PULCINI | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 GREENE ST APT A | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309011736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702622510 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2919 W SWANN AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336094050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133815200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2021 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY11134 | FL | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | PY11134 | FL | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | PY11134 | FL | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.