MEDICARE: DR. ELIZABETH MARIA MELNYCHUK D.O.

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	207Q00000X	Family Medicine Physician	054752	CT
2	207Q00000X	Family Medicine Physician	198820	NY
3	207Q00000X	Family Medicine Physician	83834	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629263397	OTHER	CT	1316369895

General Provider Information

NPI Number	:	1629263397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH MARIA MELNYCHUK D.O.

Provider Business Mailing Address
First Line	:	5750 JOHNSTON ST STE 205
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-5345
Country	:	US
Telephone Number	:	337-991-9276
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4809
Country	:	US
Telephone Number	:	337-991-9276
Fax Number	:

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	10/07/2025

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