Provider Demographics
NPI:1538514146
Name:BURCHILL, MELISSA LAVIN (RD (REGISTERED DIA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LAVIN
Last Name:BURCHILL
Suffix:
Gender:F
Credentials:RD (REGISTERED DIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EAST 60TH ST.
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-737-9000
Mailing Address - Fax:212-223-5700
Practice Address - Street 1:30 EAST 60TH ST. SUITE 302
Practice Address - Street 2:COMPLETE WELLNESS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-737-9000
Practice Address - Fax:212-223-5700
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605519-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered