Active NPI
Mardelyn Sharifi
- Registered Dietitian
- Lakewood, WA
National Provider Identifier
1053502633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI00001637
- Practice address
- 11315 Bridgeport Way SW
Lakewood, WA 98499-3004 - Phone
- (253) 426-6753
- Fax
- (253) 426-6014
- NPI assigned
- Aug 7, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DI00001637 | WA | Primary |
Addresses
Primary practice location
11315 Bridgeport Way SW
Lakewood, WA 98499-3004
Mailing address
11315 Bridgeport Way SW
Lakewood, WA 98499-3004
Phone (253) 426-6753
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI00001637 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186444800000",
"number": "1053502633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11315 BRIDGEPORT WAY SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984993004",
"telephone_number": "253-426-6753",
"fax_number": "253-426-6014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11315 BRIDGEPORT WAY SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984993004",
"telephone_number": "253-426-6753",
"fax_number": "253-426-6014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHARIFI",
"first_name": "MARDELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-07",
"last_updated": "2007-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI00001637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.