Provider Demographics
NPI:1083156384
Name:YAMASHIRO, MELISSA (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:YAMASHIRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 S 3000 E
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6923
Mailing Address - Country:US
Mailing Address - Phone:801-944-3199
Mailing Address - Fax:801-944-3180
Practice Address - Street 1:620 MEDICAL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5084
Practice Address - Country:US
Practice Address - Phone:801-298-0057
Practice Address - Fax:801-298-9765
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7520165-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical