Provider Demographics
NPI:1447603667
Name:SOBOLEWSKI, MELANIE ANN (RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:SOBOLEWSKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 PHEASANT RUN ST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4353
Mailing Address - Country:US
Mailing Address - Phone:608-792-2585
Mailing Address - Fax:
Practice Address - Street 1:2029 PHEASANT RUN ST
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4353
Practice Address - Country:US
Practice Address - Phone:608-792-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3701133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered