Healthcare Provider Details

I. General information

NPI: 1013641380
Provider Name (Legal Business Name): MELISSA GODDEAU RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA GILBERT

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 MONROE AVE STE 213
ROCHESTER NY
14618-4726
US

IV. Provider business mailing address

3380 MONROE AVE STE 213
ROCHESTER NY
14618-4726
US

V. Phone/Fax

Practice location:
  • Phone: 585-563-9000
  • Fax: 585-301-4895
Mailing address:
  • Phone: 585-563-9000
  • Fax: 585-301-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86211362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: