Provider Demographics
NPI:1457448003
Name:MELENDEZ, SESTHERS LAVERNE (PA-C)
Entity Type:Individual
Prefix:
First Name:SESTHERS
Middle Name:LAVERNE
Last Name:MELENDEZ
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 1:1134 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524
Mailing Address - Country:US
Mailing Address - Phone:919-898-5424
Mailing Address - Fax:
Practice Address - Street 1:BLDG 5-4257 REILLY RD
Practice Address - Street 2:
Practice Address - City:FT. BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 3443363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant