Healthcare Provider Details

I. General information

NPI: 1093105561
Provider Name (Legal Business Name): MELISSA PARISI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date: 11/20/2019
Reactivation Date: 12/05/2019

III. Provider practice location address

401 ROUTE 73 NORTH BUILDING 10 SUITE 320
MARLTON NJ
08053
US

IV. Provider business mailing address

100 KINGS WAY E STE D2
SEWELL NJ
08080-2238
US

V. Phone/Fax

Practice location:
  • Phone: 856-335-4118
  • Fax:
Mailing address:
  • Phone: 844-542-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86051812
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: