Provider Demographics
NPI:1629263397
Name:MELNYCHUK, ELIZABETH MARIA (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARIA
Last Name:MELNYCHUK
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:5750 JOHNSTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5345
Mailing Address - Country:US
Mailing Address - Phone:337-991-9276
Mailing Address - Fax:
Practice Address - Street 1:6650 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4809
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054752207Q00000X
NY198820207Q00000X
SC83834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1629263397Other1316369895