Provider Demographics
NPI:1669846945
Name:LISCHUK, SUE C
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:C
Last Name:LISCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 EAST LANCASTER AVENUE
Mailing Address - Street 2:2ND FLOOR EAST
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335
Mailing Address - Country:US
Mailing Address - Phone:484-876-1447
Mailing Address - Fax:484-848-5183
Practice Address - Street 1:341 EAST LANCASTER AVENUE
Practice Address - Street 2:2ND FLOOR EAST
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:484-876-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1102177133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103610712Medicaid