Provider Demographics
NPI:1265439376
Name:BRILEY, MELISSA STRUWE (MS, PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:STRUWE
Last Name:BRILEY
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5699 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6164
Mailing Address - Country:US
Mailing Address - Phone:801-201-5000
Mailing Address - Fax:
Practice Address - Street 1:1743 REDSTONE DRIVE SUITE 115
Practice Address - Street 2:REDSTONE HEALTH CENTER
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098
Practice Address - Country:US
Practice Address - Phone:435-658-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98-289413-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP71604Medicare UPIN