Healthcare Provider Details

I. General information

NPI: 1518936756
Provider Name (Legal Business Name): MELINDA CHRISTINE SULLIVAN MPAS PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10663 RAYSTOWN RD SUITE B
HUNTINGDON PA
16652-7542
US

IV. Provider business mailing address

10663 RAYSTOWN RD SUITE B
HUNTINGDON PA
16652-7542
US

V. Phone/Fax

Practice location:
  • Phone: 814-627-0071
  • Fax: 814-627-0315
Mailing address:
  • Phone: 814-627-0071
  • Fax: 814-627-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA002783L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA00077L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: