Provider Demographics
NPI:1578848040
Name:BUELL, MELYNDA SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELYNDA
Middle Name:SUE
Last Name:BUELL
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 1:6112 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4955
Mailing Address - Country:US
Mailing Address - Phone:480-924-4422
Mailing Address - Fax:480-924-4140
Practice Address - Street 1:6112 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4955
Practice Address - Country:US
Practice Address - Phone:480-924-4422
Practice Address - Fax:480-924-4140
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4959207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine