Provider Demographics
NPI:1851563274
Name:LEWIS, MELISSA LOUISE (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LOUISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 NEW RD # D-82016
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1046
Mailing Address - Country:US
Mailing Address - Phone:609-927-1030
Mailing Address - Fax:609-927-9985
Practice Address - Street 1:2106 NEW RD STE D8
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1050
Practice Address - Country:US
Practice Address - Phone:609-927-1030
Practice Address - Fax:609-927-9985
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00195100363AM0700X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical