Provider Demographics
NPI:1023555299
Name:SELEYO, MELISSA A (CRNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:SELEYO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 STATE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2233
Mailing Address - Country:US
Mailing Address - Phone:412-625-2636
Mailing Address - Fax:412-625-2627
Practice Address - Street 1:2419 STATE AVE STE 200
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2233
Practice Address - Country:US
Practice Address - Phone:412-625-2636
Practice Address - Fax:412-625-2627
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103256442Medicaid
13964708OtherCAQH
PA103256442Medicaid