Provider Demographics
NPI:1174154868
Name:GRAVES, MELIE (MHA, RD, CDN)
Entity type:Individual
Prefix:
First Name:MELIE
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MHA, RD, CDN
Other - Prefix:
Other - First Name:MYLOI
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6254 97TH PL APT 4N
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6254 97TH PL APT 4N
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1352
Practice Address - Country:US
Practice Address - Phone:347-526-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered