Healthcare Provider Details

I. General information

NPI: 1255395703
Provider Name (Legal Business Name): MELISSA MARIE SULKOWSKI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 W 26TH ST
ERIE PA
16508-1256
US

IV. Provider business mailing address

1741 W 26TH ST
ERIE PA
16508-1256
US

V. Phone/Fax

Practice location:
  • Phone: 814-455-1301
  • Fax: 814-455-5656
Mailing address:
  • Phone: 814-455-1301
  • Fax: 814-455-5656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC001160
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN509647L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: