Provider Demographics
NPI:1861079766
Name:MELNIK, KELLY JEAN (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:MELNIK
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:LINEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:1 OLD VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1123
Mailing Address - Country:US
Mailing Address - Phone:914-584-8561
Mailing Address - Fax:
Practice Address - Street 1:297 KNOLLWOOD RD STE 304
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1849
Practice Address - Country:US
Practice Address - Phone:914-693-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86105792OtherCOMMISSION ON DIETETIC REGISTRATION