MEDICARE: THE COMPOSITION DIETITIAN

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

General Provider Information

NPI Number	:	1881231843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COMPOSITION DIETITIAN

Provider Business Mailing Address
First Line	:	1804 MIDWOOD DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-2325
Country	:	US
Telephone Number	:	919-909-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 MIDWOOD DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-2325
Country	:	US
Telephone Number	:	919-909-4601
Fax Number	:

Authorized Official
Title or Position	:	OWNER/RD
Name	:	ADDIE CLAIRE MERLETTI
Credential	:	RD
Telephone Number	:	919-909-4601

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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Directions to “THE COMPOSITION DIETITIAN ” Practice Location

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