Provider Demographics
NPI:1104579267
Name:BARBOSA, MELANIE R (PA-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:R
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3550 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1078
Mailing Address - Country:US
Mailing Address - Phone:413-867-2501
Mailing Address - Fax:
Practice Address - Street 1:100 WASON AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1179
Practice Address - Country:US
Practice Address - Phone:413-733-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant