Healthcare Provider Details

I. General information

NPI: 1871258004
Provider Name (Legal Business Name): MELISSA ANNE STASIAK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 WESTFORK DR STE 401
BATON ROUGE LA
70827-0004
US

IV. Provider business mailing address

2718 BELL ST
NEW ORLEANS LA
70119-3325
US

V. Phone/Fax

Practice location:
  • Phone: 855-212-2273
  • Fax:
Mailing address:
  • Phone: 617-710-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: