Provider Demographics
NPI:1508115874
Name:DWYER, MELANIE MILLER (RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MILLER
Last Name:DWYER
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 1:10205 FOUR MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8701
Mailing Address - Country:US
Mailing Address - Phone:980-339-8330
Mailing Address - Fax:877-927-2987
Practice Address - Street 1:10205 FOUR MILE CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8701
Practice Address - Country:US
Practice Address - Phone:980-339-8330
Practice Address - Fax:877-927-2987
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003980133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered