Basic Information
| Provider Information | |||||||||
| NPI: | 1861616054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOMERS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ROSETTA | ||||||||
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| Credential: | RDN, LD/N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9680 PINES BLVD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330246246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543676192 | ||||||||
| FaxNumber: | 3058051772 | ||||||||
| Practice Location | |||||||||
| Address1: | 9680 PINES BLVD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330246246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543676192 | ||||||||
| FaxNumber: | 3058051772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 10/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND4640 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | ND4640 | 01 | FL | DIATITIAN NUTRITIONIST LI | OTHER | 884102 | 01 | FL | CDR | OTHER |