Provider Demographics
NPI:1790166692
Name:OSBORNE, MELODY LYNNE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:LYNNE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7720 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2306
Mailing Address - Country:US
Mailing Address - Phone:757-679-1972
Mailing Address - Fax:
Practice Address - Street 1:2075 GLENN MITCHELL DR
Practice Address - Street 2:SUITE 512
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0179
Practice Address - Country:US
Practice Address - Phone:757-507-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004970363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical