Healthcare Provider Details

I. General information

NPI: 1588738520
Provider Name (Legal Business Name): ANDREA MELICHAREK ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 EAGLE RD
ST DAVIDS PA
19087-3617
US

IV. Provider business mailing address

825 MANSFIELD RD W
BORDENTOWN NJ
08505-4512
US

V. Phone/Fax

Practice location:
  • Phone: 610-225-5461
  • Fax:
Mailing address:
  • Phone: 609-731-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003700
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierRT003700
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAT LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: