MEDICARE: MISS MELODY L OSBORNE 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	0110004970	VA
2	363AS0400X	Surgical Physician Assistant	0110-004970	VA

General Provider Information

NPI Number	:	1790166692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELODY L OSBORNE PA-C

Provider Business Mailing Address
First Line	:	7720 NEWPORT AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23505-2306
Country	:	US
Telephone Number	:	757-679-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	2075 GLENN MITCHELL DR
Second Line	:	SUITE 512
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-0179
Country	:	US
Telephone Number	:	757-507-8850
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	01/27/2026

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