Healthcare Provider Details

I. General information

NPI: 1366837957
Provider Name (Legal Business Name): SALEEMAH FLYTHE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 TILLMAN DR SUITE 120
BENSALEM PA
19020-2029
US

IV. Provider business mailing address

3260 TILLMAN DR SUITE 120
BENSALEM PA
19020-2029
US

V. Phone/Fax

Practice location:
  • Phone: 215-305-8834
  • Fax: 267-332-0323
Mailing address:
  • Phone: 215-305-8834
  • Fax: 267-332-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTMA053014
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: