Provider Demographics
NPI:1942392493
Name:BENEDICT, MELINDA ANN (MS, RD, LD/N, CDCES)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ANN
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:MS, RD, LD/N, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 OAK COMMON AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-6803
Mailing Address - Country:US
Mailing Address - Phone:904-318-4328
Mailing Address - Fax:
Practice Address - Street 1:5737 BARNHILL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7189
Practice Address - Country:US
Practice Address - Phone:904-686-6800
Practice Address - Fax:904-212-0488
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
FLND169133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6899YMedicare ID - Type Unspecified