Provider Demographics
NPI:1679886048
Name:SALONIA, MELISSA S (PA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:SALONIA
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 1:896 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2912
Mailing Address - Country:US
Mailing Address - Phone:860-788-3632
Mailing Address - Fax:860-788-2085
Practice Address - Street 1:896 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2912
Practice Address - Country:US
Practice Address - Phone:860-788-3632
Practice Address - Fax:860-788-2085
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002452363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400195962Medicare PIN
CTD400083029Medicare PIN