Individual
MELISSA CHANTELAU
Active
Individual
MELISSA CHANTELAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MMS, PA-C, LAT/ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
RT005244
PA
363AS0400X
Surgical Physician Assistant
Primary
MA060458
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA060458
STATE LICENSE
PA
Enumeration date
11/07/2013
Last updated
05/23/2022
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