Stefana Fanelli, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86102779 Issued in MI

Practice address

25710 Kelly Rd Ste 1
Roseville, MI 48066-4959

Phone

(586) 772-2600

Fax

(586) 772-5289

NPI assigned

Apr 1, 2021

Last updated

Apr 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

State licenses

Interoperability endpoints

• Direct secure messaging: sfanelli@kidneyconsultants.org

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1063090777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25710 KELLY RD STE 1",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664959",
            "telephone_number": "586-772-2600",
            "fax_number": "586-772-5289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25710 KELLY RD STE 1",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664959",
            "telephone_number": "586-772-2600",
            "fax_number": "586-772-5289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANELLI",
        "first_name": "STEFANA",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-01",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "MI",
            "license": "86102779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Sfanelli@kidneyconsultants.org",
            "affiliation": "N",
            "address_1": "10 Corporate Dr Ste 300",
            "city": "Burlington",
            "state": "MA",
            "country_code": "US",
            "postal_code": "018034200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Registered Dietitian in Roseville, MI
• Providers in Roseville, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.