Provider Demographics
NPI:1710445150
Name:SMITH, MELISSA HATTON (RDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:HATTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MORETZ-SOHN
Other - Last Name:HATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3226 GREENWICH VILLAGE BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7575
Mailing Address - Country:US
Mailing Address - Phone:870-703-4976
Mailing Address - Fax:406-605-0881
Practice Address - Street 1:3226 GREENWICH VILLAGE BLVD APT 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7575
Practice Address - Country:US
Practice Address - Phone:870-703-4976
Practice Address - Fax:406-605-0881
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86050111133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered