Healthcare Provider Details

I. General information

NPI: 1770115289
Provider Name (Legal Business Name): MELISSA LEWIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 E VIRGINIA BEACH BLVD STE 303
NORFOLK VA
23502-2851
US

IV. Provider business mailing address

6275 E VIRGINIA BEACH BLVD STE 303
NORFOLK VA
23502-2851
US

V. Phone/Fax

Practice location:
  • Phone: 757-451-3141
  • Fax:
Mailing address:
  • Phone: 757-461-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number0110007317
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: