Provider Demographics
NPI:1013065366
Name:KIRDZIK, MELISSA (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KIRDZIK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2610
Mailing Address - Country:US
Mailing Address - Phone:401-486-7089
Mailing Address - Fax:
Practice Address - Street 1:195 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2610
Practice Address - Country:US
Practice Address - Phone:401-486-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI002683999OtherUNITED HEALTH
RI31814-3OtherBLUE CROSS BLUE SHIELD
RI413226OtherBCBS-BLUECHIP
RI31808OtherNEIGHBORHOOD HEALTH PLAN