Provider Demographics
NPI:1164115689
Name:CONNOR, MELISSA (MA, RDN/ LDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MA, RDN/ LDN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN/ LDN
Mailing Address - Street 1:720 MONROE ST STE E512
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6360
Mailing Address - Country:US
Mailing Address - Phone:917-647-1557
Mailing Address - Fax:
Practice Address - Street 1:720 MONROE ST STE E512
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6360
Practice Address - Country:US
Practice Address - Phone:917-647-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8695133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered