Provider Demographics
NPI:1497342133
Name:BERDY, MELANIE ROSE (RDN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ROSE
Last Name:BERDY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20076
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18502-0076
Mailing Address - Country:US
Mailing Address - Phone:845-709-2448
Mailing Address - Fax:
Practice Address - Street 1:930 MEADOW AVE UNIT 309
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2575
Practice Address - Country:US
Practice Address - Phone:845-709-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist