Provider Demographics
NPI:1356087035
Name:PIERRE-JEAN, MELODY (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:PIERRE-JEAN
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 WHITE HALL DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-3922
Mailing Address - Country:US
Mailing Address - Phone:386-569-9515
Mailing Address - Fax:
Practice Address - Street 1:120 AIRPORT RD STE 2A
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2388
Practice Address - Country:US
Practice Address - Phone:386-313-7264
Practice Address - Fax:386-437-8207
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9458133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered