Provider Demographics
NPI:1467406264
Name:DEYOUNG, MELANIE DENISE (PA-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DENISE
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:DENISE
Other - Last Name:SKIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5155 E. EAGLE DRIVE
Mailing Address - Street 2:#20730
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-3031
Mailing Address - Country:US
Mailing Address - Phone:480-706-9430
Mailing Address - Fax:480-378-2273
Practice Address - Street 1:2223 E BASELINE RD STE A
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2336
Practice Address - Country:US
Practice Address - Phone:480-835-5302
Practice Address - Fax:480-844-2081
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ813594Medicaid
BS8530986OtherDEA
AZZ149572Medicare PIN