Provider Demographics
NPI:1699803858
Name:HIRSCH, MELYNDA JOY (MS,RD,CDN)
Entity type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:JOY
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MS,RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2317
Mailing Address - Country:US
Mailing Address - Phone:631-348-7932
Mailing Address - Fax:
Practice Address - Street 1:321 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2317
Practice Address - Country:US
Practice Address - Phone:631-376-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001685-1133V00000X
NY5221251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered