Provider Demographics
NPI:1083245864
Name:ROBERTS, MELINDA MOYER (MS, RDN, LDN, CHC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MOYER
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 KENMARA DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2022
Mailing Address - Country:US
Mailing Address - Phone:484-356-8784
Mailing Address - Fax:
Practice Address - Street 1:609 W GERMANTOWN PIKE BLDG SUITE140
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4243
Practice Address - Country:US
Practice Address - Phone:484-622-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01377133V00000X
PADN003530133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered