Provider Demographics
NPI:1184068397
Name:PETERS, MELISSA (DSC, MHNE)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:DSC, MHNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LEGARE CT
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2901
Mailing Address - Country:US
Mailing Address - Phone:561-632-0478
Mailing Address - Fax:
Practice Address - Street 1:240 W INDIANTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3548
Practice Address - Country:US
Practice Address - Phone:561-632-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education