Healthcare Provider Details

I. General information

NPI: 1841858495
Provider Name (Legal Business Name): MELISSA LITWAK MS, RD, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 FIELDSTONE RD
STAMFORD CT
06902-2575
US

IV. Provider business mailing address

77 FIELDSTONE RD
STAMFORD CT
06902-2575
US

V. Phone/Fax

Practice location:
  • Phone: 561-703-8352
  • Fax:
Mailing address:
  • Phone: 561-703-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number59.001719
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number59.001719
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number59.001719
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number59.001719
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: