Provider Demographics
NPI:1033442017
Name:BUNCE, MELISSA M (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:BUNCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:3404 26TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-3537
Practice Address - Country:US
Practice Address - Phone:727-318-6880
Practice Address - Fax:727-321-0890
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ6696363A00000X
TXPA07003363A00000X
NY363A00000X
FLPA9115504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400012196Medicare PIN