Provider Demographics
NPI:1891106506
Name:MARLOWE, MELISSA (RD, CDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MARLOWE
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HIGH MANOR DR APT 7
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9105
Mailing Address - Country:US
Mailing Address - Phone:585-474-6975
Mailing Address - Fax:
Practice Address - Street 1:2060 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2792
Practice Address - Country:US
Practice Address - Phone:585-271-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008012-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered