Provider Demographics
NPI:1770908097
Name:SIMS, MELANIE (RD, LD/N)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:WEBBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD/N
Mailing Address - Street 1:15720 JOHN J DELANEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3430
Mailing Address - Country:US
Mailing Address - Phone:704-549-9550
Mailing Address - Fax:704-549-9570
Practice Address - Street 1:15720 JOHN J DELANEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3430
Practice Address - Country:US
Practice Address - Phone:704-549-9550
Practice Address - Fax:704-549-9570
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004334133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered