Healthcare Provider Details

I. General information

NPI: 1275889206
Provider Name (Legal Business Name): MELINDA M JOHNSTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA M COESFELD PA-C

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-8063
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-8082
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2689
  • Fax: 860-679-1754
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number007626
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.001122
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: