Individual provider Active NPI

Gaylia Jaudon, RDN

  • Registered Dietitian
  • Dade City, FL
National Provider Identifier
1114632916
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
ND9765 Issued in FL
Practice address
32392 Rusty Creek TRL
Dade City, FL 33525-7955
Phone
(813) 298-9882
NPI assigned
Jan 17, 2023
Last updated
Jan 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X ND9765 FL Primary

Addresses

Primary practice location

32392 Rusty Creek TRL
Dade City, FL 33525-7955

Mailing address

32392 Rusty Creek TRL
Dade City, FL 33525-7955
Phone (813) 298-9882

Other identifiers 1

IdentifierTypeStateIssuer
ND9765MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL telehealth Other

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
ND9765FLMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Be My Shape Nutrition & Wellness LLC Dietitian, Registered CurrentSince Mar 19, 2023 Accepting new patients

Organizations & group practices 1

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": "1673913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1114632916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32392 RUSTY CREEK TRL",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335257955",
            "telephone_number": "813-298-9882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32392 RUSTY CREEK TRL",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335257955",
            "telephone_number": "813-298-9882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAUDON",
        "first_name": "GAYLIA",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-17",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND9765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ND9765",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "telehealth",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "telehealth",
            "address_1": "32392 Rusty Creek Trl",
            "city": "Dade City",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335257955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dade City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.