Provider Demographics
NPI:1730071002
Name:AZZAM, MELIA (RD)
Entity type:Individual
Prefix:
First Name:MELIA
Middle Name:
Last Name:AZZAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7038 BAKERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1160
Mailing Address - Country:US
Mailing Address - Phone:904-200-5292
Mailing Address - Fax:
Practice Address - Street 1:7038 BAKERSFIELD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1160
Practice Address - Country:US
Practice Address - Phone:904-200-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12081133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered