Healthcare Provider Details

I. General information

NPI: 1265439376
Provider Name (Legal Business Name): MELISSA STRUWE BRILEY MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 REDSTONE DRIVE SUITE 115 REDSTONE HEALTH CENTER
PARK CITY UT
84098
US

IV. Provider business mailing address

5699 FAIRVIEW DR
PARK CITY UT
84098-6164
US

V. Phone/Fax

Practice location:
  • Phone: 435-658-9200
  • Fax:
Mailing address:
  • Phone: 801-201-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number98-289413-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: