Provider Demographics
NPI:1013145770
Name:COLVILLE, MELANIE SHAY (MS, RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:SHAY
Last Name:COLVILLE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LYNNE
Other - Last Name:SHAY
Other - Suffix:IV
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:222 W THOMAS RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4419
Mailing Address - Country:US
Mailing Address - Phone:602-406-3611
Mailing Address - Fax:602-406-4363
Practice Address - Street 1:222 W THOMAS RD
Practice Address - Street 2:SUITE 304
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4419
Practice Address - Country:US
Practice Address - Phone:602-406-3611
Practice Address - Fax:602-406-4363
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
886208OtherCOMMISSION ON DIETETIC REGISTRATION