Provider Demographics
NPI:1790518710
Name:SUAREZ, MELISSA (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SERRATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:299 S MAIN ST
Mailing Address - Street 2:SUITE 1300 PMB 94922
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111
Mailing Address - Country:US
Mailing Address - Phone:385-202-3140
Mailing Address - Fax:
Practice Address - Street 1:299 S MAIN ST
Practice Address - Street 2:SUITE 1300 PMB 94922
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111
Practice Address - Country:US
Practice Address - Phone:385-202-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical