Provider Demographics
NPI:1356919138
Name:VALLIANT, MELINDA WELLS (PHD, RDN, CSSD, LDN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:WELLS
Last Name:VALLIANT
Suffix:
Gender:F
Credentials:PHD, RDN, CSSD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SORORITY ROW
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655
Mailing Address - Country:US
Mailing Address - Phone:662-915-1437
Mailing Address - Fax:662-915-7039
Practice Address - Street 1:108 SORORITY ROW
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-915-1437
Practice Address - Fax:662-915-7039
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD0537133VN1501X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics