Healthcare Provider Details

I. General information

NPI: 1528704608
Provider Name (Legal Business Name): MELISSA LYCHAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 HAMILTON ST
ALLENTOWN PA
18104-5656
US

IV. Provider business mailing address

24 S 18TH ST
ALLENTOWN PA
18104-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-628-8372
  • Fax:
Mailing address:
  • Phone: 610-628-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN655202
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN655202
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: