Provider Demographics
NPI:1700469376
Name:SANDERS, MELISSA (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHEYNEY
Mailing Address - State:PA
Mailing Address - Zip Code:19319-1016
Mailing Address - Country:US
Mailing Address - Phone:267-800-5170
Mailing Address - Fax:
Practice Address - Street 1:30 LACRUE AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1042
Practice Address - Country:US
Practice Address - Phone:610-558-4800
Practice Address - Fax:610-558-4844
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0011615363LF0000X
PASP023221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily