Provider Demographics
NPI:1124398300
Name:FLYNN, MELISSA ANNE (RD, CDN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RD, CDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SHERMAN PL
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3028
Mailing Address - Country:US
Mailing Address - Phone:716-860-5902
Mailing Address - Fax:
Practice Address - Street 1:44 SHERMAN PL
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3028
Practice Address - Country:US
Practice Address - Phone:716-860-5902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-42314174N00000X
NY007327133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN