Provider Demographics
NPI:1871280420
Name:SCHULTZ, MELANIE SUE (RD,LD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:SUE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:SUE
Other - Last Name:THEROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD
Mailing Address - Street 1:4624 NW KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-1297
Mailing Address - Country:US
Mailing Address - Phone:785-969-6361
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered