Provider Demographics
NPI:1316178098
Name:ZDEB, MELISSA LYNN (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:LYNN
Last Name:ZDEB
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MCLEAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-1830
Mailing Address - Country:US
Mailing Address - Phone:847-717-3400
Mailing Address - Fax:224-629-4308
Practice Address - Street 1:101 S MCLEAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1830
Practice Address - Country:US
Practice Address - Phone:847-717-3400
Practice Address - Fax:224-629-4308
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered