Provider Demographics
NPI:1619172715
Name:BENNETT, MELISSA R (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:R
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 BRACE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3524
Mailing Address - Country:US
Mailing Address - Phone:856-795-3131
Mailing Address - Fax:856-354-0562
Practice Address - Street 1:1417 BRACE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3524
Practice Address - Country:US
Practice Address - Phone:856-795-3131
Practice Address - Fax:856-354-0562
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal