Provider Demographics
NPI:1649552605
Name:MELANSON, AMY BLEASE (RD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BLEASE
Last Name:MELANSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 AUBURN CT
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6901
Mailing Address - Country:US
Mailing Address - Phone:510-814-0282
Mailing Address - Fax:
Practice Address - Street 1:1025 AUBURN CT
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6901
Practice Address - Country:US
Practice Address - Phone:510-814-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80977133V00000X
863256133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered