Healthcare Provider Details

I. General information

NPI: 1437552676
Provider Name (Legal Business Name): MELANIE NEWKIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S NUTRITIONAL SERVICES
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

501 6TH AVE S NUTRITIONAL SERVICES
ST PETERSBURG FL
33701-4634
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-3384
  • Fax:
Mailing address:
  • Phone: 727-767-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: