Provider Demographics
NPI:1790878452
Name:DOHERTY, MELANIE ELAINE (RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELAINE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15186 FIDDLENECK LANE
Mailing Address - Street 2:
Mailing Address - City:PRATHER
Mailing Address - State:CA
Mailing Address - Zip Code:93651
Mailing Address - Country:US
Mailing Address - Phone:559-322-9460
Mailing Address - Fax:
Practice Address - Street 1:1303 EAST HERNDON
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-450-3365
Practice Address - Fax:559-450-5473
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA833714133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered