Healthcare Provider Details

I. General information

NPI: 1790645802
Provider Name (Legal Business Name): KATHERINE MELCHIONNI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 SILVERSIDE RD STE 107
WILMINGTON DE
19810-4812
US

IV. Provider business mailing address

130 MONUMENT RD APT 645
BALA CYNWYD PA
19004-1774
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-8532
  • Fax:
Mailing address:
  • Phone: 518-577-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: