Provider Demographics
NPI:1881323269
Name:VELASQUEZ, MELISSA STEPHANIE (PA)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:STEPHANIE
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:14 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-3001
Mailing Address - Country:US
Mailing Address - Phone:908-884-9108
Mailing Address - Fax:
Practice Address - Street 1:591 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1284
Practice Address - Country:US
Practice Address - Phone:973-916-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00703400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant