Provider Demographics
NPI:1457820458
Name:FORSYTH, MELANIE MARIE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARIE
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9353 VISCOUNT BLVD APT 1015
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-8004
Mailing Address - Country:US
Mailing Address - Phone:281-948-6056
Mailing Address - Fax:
Practice Address - Street 1:6151 DEW DR STE 410
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3912
Practice Address - Country:US
Practice Address - Phone:915-584-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12280363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant