Healthcare Provider Details

I. General information

NPI: 1427454438
Provider Name (Legal Business Name): MELINDA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 SYLVESTER RD SW STE 401
BURIEN WA
98166-3059
US

IV. Provider business mailing address

16259 SYLVESTER RD SW STE 401
BURIEN WA
98166-3059
US

V. Phone/Fax

Practice location:
  • Phone: 206-823-1004
  • Fax: 206-309-3319
Mailing address:
  • Phone: 206-823-1004
  • Fax: 206-309-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51963
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60865722
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: