Provider Demographics
NPI:1780160374
Name:PEREZ, MELISSA A (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:PEREZ
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 1:20311 CHARTWELL CENTER DR UNIT 403
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5291
Mailing Address - Country:US
Mailing Address - Phone:954-663-5091
Mailing Address - Fax:
Practice Address - Street 1:10801 MONROE RD STE A
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-8336
Practice Address - Country:US
Practice Address - Phone:704-841-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001008237363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical