Provider Demographics
NPI:1588482830
Name:TOMIELLO, MELANIE (RD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:TOMIELLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11861 SW CORAL COVE PKWY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-7809
Mailing Address - Country:US
Mailing Address - Phone:201-218-7444
Mailing Address - Fax:
Practice Address - Street 1:777 N BROADWAY STE 204
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1019
Practice Address - Country:US
Practice Address - Phone:914-631-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
897474133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered