Esosa Edosomwan

Primary specialty

NutritionistTaxonomy code 133N00000X

License

DX4886 Issued in MD

Practice address

3970 Chain Bridge Rd
Fairfax, VA 22030-3316

Phone

(202) 643-5703

NPI assigned

Mar 30, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Staying Ageless Inc.

  • Nutritionist
  • Houston, TX
  • NPI 1528754496
  NPD Authorized official

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1053949537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3970 CHAIN BRIDGE RD",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220303316",
            "telephone_number": "202-643-5703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3970 CHAIN BRIDGE RD",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220303316",
            "telephone_number": "202-643-5703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDOSOMWAN",
        "first_name": "ESOSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-30",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "MD",
            "license": "DX4886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "practicebetter.com",
            "affiliation": "N",
            "endpointDescription": "HIPPA Compliant Practitioner Portal",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3970 Chain Bridge Rd",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220303316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brenda Lee Edmonds
• Courtney Edmonds
• Autumn Edmondson
• Isabel Edmonson
• Edna Home Care Services LLC
• Edward R Hindman Jr DDS PC
• David Andrew Edwards
• Ellen Edwards, M.S., CCC-SLP
• Gail Ann Edwards, R.N.C.,M.S.N.,A.N.P.
• Jacey Lynn Edwards

• Nutritionist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Nutritionist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; 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.