Healthcare Provider Details

I. General information

NPI: 1659865723
Provider Name (Legal Business Name): MELISSA ANN JEWELL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MELISSA ANN PERRY

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S ORANGE AVE SUITE 104 #1817
ORLANDO FL
32801
US

IV. Provider business mailing address

255 S ORANGE AVE SUITE 104 #1817
ORLANDO FL
32801
US

V. Phone/Fax

Practice location:
  • Phone: 407-873-6568
  • Fax:
Mailing address:
  • Phone: 407-873-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7144
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: