Provider Demographics
NPI:1851355028
Name:RILEY, MELANI (RD)
Entity Type:Individual
Prefix:
First Name:MELANI
Middle Name:
Last Name:RILEY
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 1:1806 N EUCALYPTUS CT
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1213
Mailing Address - Country:US
Mailing Address - Phone:918-286-6038
Mailing Address - Fax:
Practice Address - Street 1:1806 N EUCALYPTUS CT
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1213
Practice Address - Country:US
Practice Address - Phone:918-286-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100631900AMedicaid
OK100636110BMedicaid