MEDICARE: MELANIE DA COSTA 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	363A00000X	Physician Assistant	PA9111633	FL

General Provider Information

NPI Number	:	1396216230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE DA COSTA PA-C

Provider Business Mailing Address
First Line	:	131 S FEDERAL HWY APT 106
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-4906
Country	:	US
Telephone Number	:	954-608-2889
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 S FEDERAL HWY STE J
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3321
Country	:	US
Telephone Number	:	561-320-8719
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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