Provider Demographics
NPI:1053985481
Name:MELVILLE, JAMIE LAUREN (PA)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LAUREN
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:75 HIDDEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3843
Mailing Address - Country:US
Mailing Address - Phone:973-222-1830
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical