Provider Demographics
NPI:1740586593
Name:ASSAF, MELISSA JAYNE (CPNP-PC DNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JAYNE
Last Name:ASSAF
Suffix:
Gender:F
Credentials:CPNP-PC DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W THUNDERBIRD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4710
Mailing Address - Country:US
Mailing Address - Phone:602-865-4442
Mailing Address - Fax:602-865-4507
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4710
Practice Address - Country:US
Practice Address - Phone:602-865-4442
Practice Address - Fax:602-865-4507
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3929363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1740586593Medicaid