Healthcare Provider Details

I. General information

NPI: 1619172715
Provider Name (Legal Business Name): MELISSA R. BENNETT RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 BRACE RD
CHERRY HILL NJ
08034-3524
US

IV. Provider business mailing address

1417 BRACE RD
CHERRY HILL NJ
08034-3524
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-3131
  • Fax: 856-354-0562
Mailing address:
  • Phone: 856-795-3131
  • Fax: 856-354-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: