Provider Demographics
NPI:1245540863
Name:MCCAHON, MELINA (PA)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:MCCAHON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2425 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2215
Mailing Address - Country:US
Mailing Address - Phone:916-453-2082
Mailing Address - Fax:916-453-2188
Practice Address - Street 1:2425 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2215
Practice Address - Country:US
Practice Address - Phone:916-453-2082
Practice Address - Fax:916-453-2188
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant