Basic Information
| Provider Information | |||||||||
| NPI: | 1932707130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOON | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | MPH, MMS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 MANOR RD | ||||||||
| Address2: | |||||||||
| City: | HARLEYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194381955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679183776 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10800 KNIGHTS RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191144200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156124000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2020 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | OA005299 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | MA061702 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.