=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144348905
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA ROBINSON ND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 494 GLENBROOK RD SUITE 3
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-588-1158
-----------------------------------------------------
Fax | 203-588-0257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 494 GLENBROOK RD SUITE 3
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-588-1158
-----------------------------------------------------
Fax | 203-588-0257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 000360
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------