Provider Demographics
NPI:1962848689
Name:BERKE, MELANIE MICHELLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MICHELLE
Last Name:BERKE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 CAL COVE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-6003
Mailing Address - Country:US
Mailing Address - Phone:239-233-0501
Mailing Address - Fax:
Practice Address - Street 1:834 CAL COVE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-6003
Practice Address - Country:US
Practice Address - Phone:239-233-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered