Provider Demographics
NPI:1629595517
Name:MATSUMURA, MELISSA D (MS, RD)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:D
Last Name:MATSUMURA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 COOPER TOMLINSON RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9002
Mailing Address - Country:US
Mailing Address - Phone:575-491-5614
Mailing Address - Fax:
Practice Address - Street 1:31 COOPER TOMLINSON RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9002
Practice Address - Country:US
Practice Address - Phone:575-491-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered