Provider Demographics
NPI:1013641380
Name:GODDEAU, MELISSA (RDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GODDEAU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3380 MONROE AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4726
Mailing Address - Country:US
Mailing Address - Phone:585-563-9000
Mailing Address - Fax:585-301-4895
Practice Address - Street 1:3380 MONROE AVE STE 213
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4726
Practice Address - Country:US
Practice Address - Phone:585-563-9000
Practice Address - Fax:585-301-4895
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86211362133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered