Healthcare Provider Details

I. General information

NPI: 1013145770
Provider Name (Legal Business Name): MELANIE SHAY COLVILLE MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE LYNNE SHAY IV MS, RD

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD SUITE 304
PHOENIX AZ
85013-4419
US

IV. Provider business mailing address

222 W THOMAS RD SUITE 304
PHOENIX AZ
85013-4419
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3611
  • Fax: 602-406-4363
Mailing address:
  • Phone: 602-406-3611
  • Fax: 602-406-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: