Provider Demographics
NPI:1598276123
Name:MELIKIAN, ASHLEY (MS, RD, CD/N, CNSC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MELIKIAN
Suffix:
Gender:F
Credentials:MS, RD, CD/N, CNSC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD/N, CNSC
Mailing Address - Street 1:242 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2706
Mailing Address - Country:US
Mailing Address - Phone:516-302-7066
Mailing Address - Fax:
Practice Address - Street 1:1000 ASYLUM AVE STE 1022
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1701
Practice Address - Country:US
Practice Address - Phone:860-714-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1524133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered