MEDICARE: MELINDA CHRISTINE SULLIVAN MPAS PAC

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	MA002783L	PA
2	363A00000X	Physician Assistant	OA00077L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518936756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA CHRISTINE SULLIVAN MPAS PAC

Provider Business Mailing Address
First Line	:	10663 RAYSTOWN RD
Second Line	:	SUITE B
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-7542
Country	:	US
Telephone Number	:	814-627-0071
Fax Number	:	814-627-0315

Provider Business Practice Location Address
First Line	:	10663 RAYSTOWN RD
Second Line	:	SUITE B
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-7542
Country	:	US
Telephone Number	:	814-627-0071
Fax Number	:	814-627-0315

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	12/02/2025

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Directions to “ MELINDA CHRISTINE SULLIVAN MPAS PAC” Practice Location

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