MEDICARE: MELISSA SIROLLI RD, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	008129-1	NY

General Provider Information

NPI Number	:	1114371366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SIROLLI RD, CDN

Provider Business Mailing Address
First Line	:	22 CORTLANDT ST
Second Line	:	SUITE 1632
City	:	NEW YORK
State	:	NY
Zip	:	10007-3107
Country	:	US
Telephone Number	:	212-419-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 CORTLANDT ST
Second Line	:	SUITE 1632
City	:	NEW YORK
State	:	NY
Zip	:	10007-3107
Country	:	US
Telephone Number	:	212-419-0399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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