Provider Demographics
NPI:1861863292
Name:MELLINGER, ASHLEY BROOKE (RD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BROOKE
Last Name:MELLINGER
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 1:205 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2867
Mailing Address - Country:US
Mailing Address - Phone:802-275-4732
Mailing Address - Fax:
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2867
Practice Address - Country:US
Practice Address - Phone:802-275-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0116231133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered