MEDICARE: MELISSA E. BAUMANN M.S.,R.D.,CDE,LD/N

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	ND 4941	FL

General Provider Information

NPI Number	:	1902831308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA E. BAUMANN M.S.,R.D.,CDE,LD/N

Provider Business Mailing Address
First Line	:	PO BOX 9671
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32120-9671
Country	:	US
Telephone Number	:	386-676-7130
Fax Number	:	386-676-7125

Provider Business Practice Location Address
First Line	:	201 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2724
Country	:	US
Telephone Number	:	386-238-3200
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/09/2017

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