Active NPI
Shannon Grant-Hailey, RD, CDN
- Registered Dietitian
- Bronx, NY
National Provider Identifier
1083253090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 111 E 210TH St
Bronx, NY 10467-2401 - Phone
- (718) 920-8468
- Fax
- (718) 654-7648
- NPI assigned
- Dec 23, 2019
- Last updated
- Jan 13, 2020
- 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 | NY | Primary |
Addresses
Primary practice location
111 E 210TH St
Bronx, NY 10467-2401
Mailing address
3444 Kossuth Ave
Bronx, NY 10467-2410
Phone (718) 920-8468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230116000733 | NY | Practitioner - Registered Dietitian Or Nutrition Professional | 8820469604 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578873600000",
"number": "1083253090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3444 KOSSUTH AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104672410",
"telephone_number": "718-920-8468",
"fax_number": "718-654-7648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E 210TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104672401",
"telephone_number": "718-920-8468",
"fax_number": "718-654-7648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT-HAILEY",
"first_name": "SHANNON",
"credential": "RD, CDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-23",
"last_updated": "2020-01-13",
"certification_date": "2020-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": null,
"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 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.