Provider Demographics
NPI:1124543830
Name:MASTRAPA, MELINDA SUSAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUSAN
Last Name:MASTRAPA
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 1:5130 LINTON BLVD STE F1
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6595
Mailing Address - Country:US
Mailing Address - Phone:561-495-0600
Mailing Address - Fax:561-824-0024
Practice Address - Street 1:5130 LINTON BLVD STE F1
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6595
Practice Address - Country:US
Practice Address - Phone:561-495-0600
Practice Address - Fax:561-824-0024
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110427363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical