Provider Demographics
NPI:1447409099
Name:CRAIG, MELYNDA LEIGH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELYNDA
Middle Name:LEIGH
Last Name:CRAIG
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 1:900 WARREN AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1430
Mailing Address - Country:US
Mailing Address - Phone:800-822-5981
Mailing Address - Fax:
Practice Address - Street 1:900 WARREN AVE STE 401
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1430
Practice Address - Country:US
Practice Address - Phone:800-822-5981
Practice Address - Fax:401-808-6329
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01085363A00000X, 363A00000X
PAMA053593363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant