Provider Demographics
NPI:1235632399
Name:MELANO, DIANE (NTC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MELANO
Suffix:
Gender:F
Credentials:NTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1931
Mailing Address - Country:US
Mailing Address - Phone:609-277-1712
Mailing Address - Fax:
Practice Address - Street 1:213 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1931
Practice Address - Country:US
Practice Address - Phone:609-277-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450240182133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist