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General NPI Number Information
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NPI Number | 1629263397
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Entity Type | Individual
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Provider Name | ELIZABETH MARIA MELNYCHUK D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 6650 RIVERS AVE
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4809
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Country | US
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Telephone | 337-991-9276
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Fax |
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Provider Business Mailing Address
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Address Line | 5750 JOHNSTON ST STE 205
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City | LAFAYETTE
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State | LA
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Zip | 70503-5345
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Country | US
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Telephone | 337-991-9276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 054752
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 198820
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 83834
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License Number State | SC
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