Provider Demographics
NPI:1356013627
Name:OLAH, MELISSA TERRY (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:TERRY
Last Name:OLAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12571 PERSIMMON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8977
Mailing Address - Country:US
Mailing Address - Phone:561-294-0885
Mailing Address - Fax:
Practice Address - Street 1:275 PERRY PKWY STE GANDH
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9275
Practice Address - Country:US
Practice Address - Phone:478-287-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114924363A00000X
GA12884363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant