Provider Demographics
NPI:1831823434
Name:MELILLO, SAMANTHA JEANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JEANNE
Last Name:MELILLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13655 W HIGHLAND SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-8000
Mailing Address - Country:US
Mailing Address - Phone:419-779-5955
Mailing Address - Fax:
Practice Address - Street 1:255 LEBANON RD.
Practice Address - Street 2:BUILDING A, SUITE 106
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036
Practice Address - Country:US
Practice Address - Phone:469-294-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant