1568639813 NPI number — MRS. MELISSA ANNE VERDI MS, RDN, CDN, CDCES

Table of content: MRS. MELISSA ANNE VERDI MS, RDN, CDN, CDCES (NPI 1568639813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568639813 NPI number — MRS. MELISSA ANNE VERDI MS, RDN, CDN, CDCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERDI
Provider First Name:
MELISSA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, CDN, CDCES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALDORF
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RD, CDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568639813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 KELLY ANN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14086-1413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9097 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARENCE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14031-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-222-0297
Provider Business Practice Location Address Fax Number:
716-794-9466
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  0064931 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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