Provider Demographics
NPI:1609017300
Name:LEWONUK, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LEWONUK
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 1:945 AUTUMN RUN
Mailing Address - Street 2:
Mailing Address - City:WEDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29168-9264
Mailing Address - Country:US
Mailing Address - Phone:803-983-2530
Mailing Address - Fax:803-494-5779
Practice Address - Street 1:945 AUTUMN RUN
Practice Address - Street 2:
Practice Address - City:WEDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29168-9264
Practice Address - Country:US
Practice Address - Phone:803-983-2530
Practice Address - Fax:803-494-5779
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0800052432246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic