Provider Demographics
NPI:1073722989
Name:HEIL, MELISSA S (RD,LD,IBCLC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:HEIL
Suffix:
Gender:F
Credentials:RD,LD,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20132 SW 83RD ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-5282
Mailing Address - Country:US
Mailing Address - Phone:352-489-7631
Mailing Address - Fax:
Practice Address - Street 1:3700 W SOVEREIGN PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8071
Practice Address - Country:US
Practice Address - Phone:352-795-6233
Practice Address - Fax:352-795-0167
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered