Provider Demographics
NPI:1790913937
Name:WAWRZYNEK, MELISSA (DPM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WAWRZYNEK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 1ST AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4033
Mailing Address - Country:US
Mailing Address - Phone:610-822-3900
Mailing Address - Fax:610-822-3820
Practice Address - Street 1:860 1ST AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4033
Practice Address - Country:US
Practice Address - Phone:610-822-3900
Practice Address - Fax:610-822-3820
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006151213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery