Provider Demographics
NPI:1801123856
Name:SULLIVAN, MELISSA A (RD, CD-N)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:
Credentials:RD, CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JONATHAN DR
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3885
Mailing Address - Country:US
Mailing Address - Phone:860-670-0611
Mailing Address - Fax:
Practice Address - Street 1:10 JONATHAN DR
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3885
Practice Address - Country:US
Practice Address - Phone:860-670-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered