Provider Demographics
NPI:1598052078
Name:BOJANG, MELODY (MFCS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:BOJANG
Suffix:
Gender:F
Credentials:MFCS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 BRIDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3534
Mailing Address - Country:US
Mailing Address - Phone:919-455-5585
Mailing Address - Fax:
Practice Address - Street 1:210 S MCLEAN BLVD
Practice Address - Street 2:1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6161
Practice Address - Country:US
Practice Address - Phone:919-455-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012030061133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered