Basic Information
Provider Information
NPI: 1417364530
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAWIN
FirstName: MELISSA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2938 KNIGHTS RD
Address2:  
City: BENSALEM
State: PA
PostalCode: 190203574
CountryCode: US
TelephoneNumber: 2156391460
FaxNumber: 2156396653
Practice Location
Address1: 10800 KNIGHTS RD
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191144200
CountryCode: US
TelephoneNumber: 2156124000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/21/2014
LastUpdateDate: 01/26/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XMA057009PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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