Provider Demographics
NPI:1073350906
Name:BUSTAMANTE, MELANIE (PA-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 E HWY 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6053
Mailing Address - Country:US
Mailing Address - Phone:352-717-3760
Mailing Address - Fax:
Practice Address - Street 1:2345 E HWY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6053
Practice Address - Country:US
Practice Address - Phone:352-717-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant