Provider Demographics
NPI:1821694464
Name:WASIELEWSKI, MELISSA GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:WASIELEWSKI
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:449 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1115
Mailing Address - Country:US
Mailing Address - Phone:570-344-6000
Mailing Address - Fax:570-344-6002
Practice Address - Street 1:449 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1115
Practice Address - Country:US
Practice Address - Phone:570-344-6000
Practice Address - Fax:570-344-6002
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2023-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA062163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant