Provider Demographics
NPI:1366837957
Name:FLYTHE, SALEEMAH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SALEEMAH
Middle Name:
Last Name:FLYTHE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3260 TILLMAN DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2029
Mailing Address - Country:US
Mailing Address - Phone:215-305-8834
Mailing Address - Fax:267-332-0323
Practice Address - Street 1:3260 TILLMAN DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2029
Practice Address - Country:US
Practice Address - Phone:215-305-8834
Practice Address - Fax:267-332-0323
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PATMA053014363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA416086ZJB3Medicare PIN