Healthcare Provider Details

I. General information

NPI: 1871922013
Provider Name (Legal Business Name): MELISSA CHANTELAU MMS, PA-C, LAT/ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 SCHOENERSVILLE RD
BETHLEHEM PA
18017
US

IV. Provider business mailing address

1605 N CEDAR CREST BLVD STE 411
ALLENTOWN PA
18104-2323
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-8080
  • Fax:
Mailing address:
  • Phone: 484-629-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA060458
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005244
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: