Healthcare Provider Details

I. General information

NPI: 1235044751
Provider Name (Legal Business Name): MELISSA LOUISE UDALL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14539 W INDIAN SCHOOL RD STE 880
GOODYEAR AZ
85395-9279
US

IV. Provider business mailing address

18182 W MACKENZIE DR
GOODYEAR AZ
85395-5234
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-9744
  • Fax:
Mailing address:
  • Phone: 480-242-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: