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General NPI Number Information
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NPI Number | 1699597443
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Entity Type | Individual
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Provider Name | MELISSA TAKACH
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 450 TREASURE ISLAND CSWY APT 304
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City | TREASURE ISLAND
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State | FL
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Zip | 33706-1137
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Country | US
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Telephone | 803-521-1154
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Fax |
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Provider Business Mailing Address
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Address Line | 450 TREASURE ISLAND CSWY APT 304
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City | TREASURE ISLAND
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State | FL
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Zip | 33706-1137
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Country | US
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Telephone | 803-521-1154
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | 1014501
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License Number State | SC
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