Provider Demographics
NPI:1487876983
Name:PEARSALL, MELANIE J (RD, LDN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:01215-3675
Mailing Address - Country:US
Mailing Address - Phone:178-148-5607
Mailing Address - Fax:178-148-5619
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:01215-3675
Practice Address - Country:US
Practice Address - Phone:178-148-5607
Practice Address - Fax:178-148-5619
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1517133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered