Provider Demographics
NPI:1407501133
Name:BASEL, MELANIE GRACE (RD, LD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:GRACE
Last Name:BASEL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:GRACE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:439 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4669
Mailing Address - Country:US
Mailing Address - Phone:512-659-3090
Mailing Address - Fax:
Practice Address - Street 1:6835 AUSTIN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3189
Practice Address - Country:US
Practice Address - Phone:512-346-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83808133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered