Provider Demographics
NPI:1669943601
Name:STITT, MELISSA LYNN (RD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:STITT
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 1:7150 HERITAGE VILLAGE PLZ STE 201
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3064
Mailing Address - Country:US
Mailing Address - Phone:205-936-5763
Mailing Address - Fax:
Practice Address - Street 1:7150 HERITAGE VILLAGE PLZ STE 201
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3064
Practice Address - Country:US
Practice Address - Phone:205-936-5763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86001637133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered