Active NPI
Sofia Gourlides, RDN, CDN, CLC
- Registered Dietitian
- Melville, NY
National Provider Identifier
1073150710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 008813-1
- Practice address
- 5 Elderwood LN
Melville, NY 11747-1549 - Phone
- (631) 484-2366
- NPI assigned
- Dec 2, 2019
- Last updated
- Dec 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 008813-1 | NY | Primary |
Addresses
Primary practice location
5 Elderwood LN
Melville, NY 11747-1549
Mailing address
5 Elderwood LN
Melville, NY 11747-1549
Phone (631) 484-2366
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008813-1 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575244800000",
"number": "1073150710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 ELDERWOOD LN",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117471549",
"telephone_number": "631-484-2366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 ELDERWOOD LN",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117471549",
"telephone_number": "631-484-2366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOURLIDES",
"first_name": "SOFIA",
"credential": "RDN, CDN, CLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-02",
"last_updated": "2019-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "008813-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.