Provider Demographics
NPI:1295514420
Name:NELSON, MELISSA ANN (RDN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:VIAENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3069 NW 25TH WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3643
Mailing Address - Country:US
Mailing Address - Phone:320-295-9911
Mailing Address - Fax:
Practice Address - Street 1:3069 NW 25TH WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3643
Practice Address - Country:US
Practice Address - Phone:320-295-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3157133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered