Provider Demographics
NPI:1437603743
Name:MOSES, MELISSA JOHNSON (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JOHNSON
Last Name:MOSES
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:LOU
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-0238
Mailing Address - Fax:
Practice Address - Street 1:3325 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-713-7429
Practice Address - Fax:336-713-7842
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003876133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric