Provider Demographics
NPI:1598905853
Name:BERRY, MELISSA MELBA (ND)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MELBA
Last Name:BERRY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 SE OAK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1582
Mailing Address - Country:US
Mailing Address - Phone:503-961-3262
Mailing Address - Fax:
Practice Address - Street 1:4265 SW 109TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3028
Practice Address - Country:US
Practice Address - Phone:503-526-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1663175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath