Provider Demographics
NPI:1811860299
Name:OPTIMAL EDGE NUTRITION BY JACKIE LLC
Entity type:Organization
Organization Name:OPTIMAL EDGE NUTRITION BY JACKIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MELUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN
Authorized Official - Phone:484-889-1028
Mailing Address - Street 1:275 STYER RD
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-2011
Mailing Address - Country:US
Mailing Address - Phone:484-889-1028
Mailing Address - Fax:
Practice Address - Street 1:275 STYER RD
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-2011
Practice Address - Country:US
Practice Address - Phone:484-889-1028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty