Individual provider Active NPI

Stephanie Aviles, CDN

  • Registered Dietitian
  • Bronx, NY
National Provider Identifier
1063093698
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86055945
Practice address
1065 Southern Blvd
Bronx, NY 10459-2417
Phone
(718) 589-2440
NPI assigned
Apr 15, 2021
Last updated
Jan 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nutritionist 133N00000X 010478-01 NY
Registered Dietitian 133V00000X 86055945 Primary

Addresses

Primary practice location

1065 Southern Blvd
Bronx, NY 10459-2417

Mailing address

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240409003503 NY Practitioner - Registered Dietitian Or Nutrition Professional 5799123709 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urban Health Plan IncGroup PAC ID 3173517281, 158 clinicians

Practice addresses (Care Compare)

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
010478-01NYMDNutritionist

Practice roles

OrganizationSpecialtyStatusNew patients
Naz Maduro Nutrition LLC Dietitian, Registered CurrentSince Jan 28, 2024 Accepting new patients
Urban Health Plan, Inc. CurrentSince May 11, 2024 Accepting new patients
Urban Health Plan, Inc. CurrentSince May 11, 2024 Accepting new patients
BSH Health PA Dietitian, Registered CurrentSince Feb 1, 2026 Accepting new patients

Locations

1065 Southern Blvd
Bronx, NY 10459
Phone 71858924404222

1515 Southern Blvd
Bronx, NY 10460
Phone (718) 589-1600

1515 Southern Blvd
#H
Bronx, NY 10460
Phone (718) 589-1600

1967 Turnbull Ave
Bronx, NY 10473
Phone (718) 684-1320

271 E 138th St
Bronx, NY 10454
Phone (347) 407-7120

3209 3rd Ave
Bronx, NY 10451
Phone (347) 284-0203

866 E Tremont Ave
Bronx, NY 10460
Phone (347) 284-0595

890 Hunts Point Ave
Bronx, NY 10474
Phone (718) 589-2141

960 Southern Blvd
Bronx, NY 10459
Phone (347) 331-6572

3712 108th St
Corona, NY 11368
Phone (718) 639-4107

11835 Queens Blvd
Ste 400
Forest Hills, NY 11375
Phone (646) 722-7610

154 W 127th St
New York, NY 10027
Phone (212) 280-0804

19 W 24th St
Fl 4
New York, NY 10010
Phone (646) 844-2332

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1063093698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104592417",
            "telephone_number": "718-589-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104592417",
            "telephone_number": "718-589-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVILES",
        "first_name": "STEPHANIE",
        "credential": "CDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-15",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NY",
            "license": "010478-01",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "86055945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.