Provider Demographics
NPI:1326175621
Name:HOLYSZKO, MELINA LYNN (PA-C, ATC)
Entity Type:Individual
Prefix:MRS
First Name:MELINA
Middle Name:LYNN
Last Name:HOLYSZKO
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3133 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3472
Mailing Address - Country:US
Mailing Address - Phone:313-565-6566
Mailing Address - Fax:313-561-5554
Practice Address - Street 1:3133 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3472
Practice Address - Country:US
Practice Address - Phone:313-565-6566
Practice Address - Fax:313-561-5554
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MI5601005863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer