MEDICARE: MRS. MELISSA KUJAT WILEY CEP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Y00000X	Clinical Exercise Physiologist

General Provider Information

NPI Number	:	1033831656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA KUJAT WILEY CEP

Provider Business Mailing Address
First Line	:	2905 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2400
Country	:	US
Telephone Number	:	804-524-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2400
Country	:	US
Telephone Number	:	804-526-0682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	06/12/2023

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