Provider Demographics
NPI:1942477633
Name:PERRYMAN, MELISSA (RD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PERRYMAN
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 1:8727 SOUTHWESTERN BLVD
Mailing Address - Street 2:# 1535
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-8283
Mailing Address - Country:US
Mailing Address - Phone:205-821-2431
Mailing Address - Fax:
Practice Address - Street 1:1935 MOTOR STREET
Practice Address - Street 2:CLINICAL NUTRITION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-456-5037
Practice Address - Fax:214-456-6287
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80792133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric