Kelly Jacqueline Zinnoury, RDN CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

48007672 Issued in NY

Practice address

1178 Broadway
3Rd FL #3135
New York, NY 10001

Phone

(917) 498-2556

NPI assigned

Nov 13, 2015

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

Other names 1

• Kelly Jacqueline Ahearn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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

• Indigenous Nutritionist

  • Registered Dietitian
  • New York, NY
  • NPI 1962870436

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1447372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1134593171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1178 BROADWAY",
            "address_2": "3RD FL #3135",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10001",
            "telephone_number": "917-498-2556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1178 BROADWAY",
            "address_2": "3RD FL #3135",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10001",
            "telephone_number": "917-498-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZINNOURY",
        "first_name": "KELLY",
        "middle_name": "JACQUELINE",
        "credential": "RDN CDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-13",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "48007672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "AHEARN",
            "middle_name": "JACQUELINE",
            "credential": "RDN CDN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vanessa Zinke, LCSW
• Janet Zinn, LCSW
• Jessica Zinn, RD
• Kim Zinn, PHD
• Olga Sol Zinner
• Lauren Elizabeth Zinns, MD
• Melissa R Zinovoy, MD
• Amy Jo Zins, M.D.
• Frania Zins, MSPT
• Zoe Zins, PSYD

• Registered Dietitian in New York, NY
• Providers in New York, NY by specialty
• Registered Dietitian in New York

• 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.