MEDICARE: MELISSA STRUWE BRILEY MS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	98-289413-1206	UT

General Provider Information

NPI Number	:	1265439376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA STRUWE BRILEY MS, PA-C

Provider Business Mailing Address
First Line	:	5699 FAIRVIEW DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6164
Country	:	US
Telephone Number	:	801-201-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1743 REDSTONE DRIVE SUITE 115
Second Line	:	REDSTONE HEALTH CENTER
City	:	PARK CITY
State	:	UT
Zip	:	84098
Country	:	US
Telephone Number	:	435-658-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	11/11/2021

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