Provider Demographics
NPI:1578893582
Name:SESERMAN, MELANIE (RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SESERMAN
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 1:54 CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1502
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:413-528-2863
Practice Address - Street 1:29 LEWIS AVE
Practice Address - Street 2:FAIRVIEW HOSPITAL FOURTH FLOOR
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1713
Practice Address - Country:US
Practice Address - Phone:413-528-8580
Practice Address - Fax:413-528-2863
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA835643133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered