Provider Demographics
NPI:1033411236
Name:SELVA, MELISSA DALEY (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DALEY
Last Name:SELVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 VETERAN DR
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-6623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:566 VETERAN DR
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-6623
Practice Address - Country:US
Practice Address - Phone:210-231-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant