Healthcare Provider Details

I. General information

NPI: 1548308398
Provider Name (Legal Business Name): MELODY FAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE SUITE 620
BELLEVUE WA
98004
US

IV. Provider business mailing address

1135 116TH AVE NE SUITE 620
BELLEVUE WA
98004
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-8016
  • Fax: 425-453-2827
Mailing address:
  • Phone: 425-454-8016
  • Fax: 425-453-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004586
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10004586
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: