MEDICARE: MRS. MELANY TELFER RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	8009	OH

General Provider Information

NPI Number	:	1417487117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANY TELFER RD, LD

Provider Business Mailing Address
First Line	:	5425 BERMUDA BAY DR APT 2D
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-6170
Country	:	US
Telephone Number	:	614-378-0978
Fax Number	:

Provider Business Practice Location Address
First Line	:	3781 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-4011
Country	:	US
Telephone Number	:	614-645-3163
Fax Number	:	614-645-5893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	03/17/2018

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