Provider Demographics
NPI:1922257377
Name:VALVO, MELANIE SUE (PA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:SUE
Last Name:VALVO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:SUE
Other - Last Name:SCHIESSL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13955
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3955
Mailing Address - Country:US
Mailing Address - Phone:843-225-8304
Mailing Address - Fax:843-225-3549
Practice Address - Street 1:1595 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5529
Practice Address - Country:US
Practice Address - Phone:843-212-8080
Practice Address - Fax:843-789-1521
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00914048OtherRR MEDICARE
SCGP1551OtherMEDICAID GROUP
SC0692PAMedicaid
SCAA32705282Medicare PIN
SC0692PAMedicaid