Provider Demographics
NPI:1033442017
Name:BUNCE, MELISSA M (PA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:BUNCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7213
Mailing Address - Country:US
Mailing Address - Phone:393-334-9555
Mailing Address - Fax:239-334-2832
Practice Address - Street 1:3487 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7213
Practice Address - Country:US
Practice Address - Phone:393-334-9555
Practice Address - Fax:239-334-2832
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6696363A00000X
TXPA07003363A00000X
NY363A00000X
FLPA9115504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400012196Medicare PIN