Melissa Fullam, RD, IBCLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86093133

Practice address

320 Brook Rd
Milton, MA 02186

Phone

(201) 925-7267

NPI assigned

Aug 7, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1508345000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 BROOK RD",
            "city": "MILTON",
            "state": "MA",
            "postal_code": "02186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 BROOK RD",
            "city": "MILTON",
            "state": "MA",
            "postal_code": "02186",
            "telephone_number": "201-925-7267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLAM",
        "first_name": "MELISSA",
        "credential": "RD, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-07",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "86093133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard G. Florentine, MD
• Jade Fortes
• Franci a. Richardson, Licsw, LLC
• Tanya Judith Frank, LICSW
• Paul Anthony Fugazzotto, D.D.S.
• Russell Fullerton, MD
• Wing Kin Fung, M.D.
• Julianne Funtsch
• Christopher Gallant, LICSW
• Daniel Gallery, PSYD

• Registered Dietitian in Milton, MA
• Providers in Milton, MA by specialty
• Registered Dietitian in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.