Doctor Name: | MELISSA ANN DESTEFANO |
NPI Number: | 1265461313 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 0110001961 |
Business Practice Address: | 16 Manor Ave Ste A Manor Family Health Center Millersville, PA - 175511132 |
Business Phone Number: | 7178725444 |
Business Fax Number: | 7178721537 |
Mailing Address: | 16 Manor Ave Ste A, Manor Family Health Center MILLERSVILLE |
State: | PA |
Postal Code: | 175511132 |
Phone Number: | 7178725444 |
Fax Number: | 7178721537 |
NPI Enumeration Date: | 07/01/2006 |
NPI Last Update Date: | 05/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 0110001961 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |