Provider Demographics
NPI:1588738520
Name:MELICHAREK, ANDREA (ATC)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:MELICHAREK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MANSFIELD RD W
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4512
Mailing Address - Country:US
Mailing Address - Phone:609-731-6202
Mailing Address - Fax:
Practice Address - Street 1:1300 EAGLE RD
Practice Address - Street 2:
Practice Address - City:ST DAVIDS
Practice Address - State:PA
Practice Address - Zip Code:19087-3617
Practice Address - Country:US
Practice Address - Phone:610-225-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0037002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART003700OtherAT LICENSE