Active NPI
Stacey Panagotopulos Federico, PHD,RD
- Registered Dietitian
- Southborough, MA
National Provider Identifier
1144320268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- CDR963741
- Practice address
- 24 Newton St
Southborough, MA 01772-1215 - Phone
- (508) 460-3291
- Fax
- (508) 453-8152
- NPI assigned
- Sep 25, 2006
- 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 | CDR963741 | RI | Primary |
Addresses
Primary practice location
24 Newton St
Southborough, MA 01772-1215
Mailing address
5 Neponset St FL Street2
Worcester, MA 01606-2714
Phone (508) 368-5532
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2625 | MA | MD | Clinical Psychologist |
| CDR963741 | RI | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reliant Medical Group, Inc | Past | Accepting new patients | |
| Reasonable Eating Decisions | Dietitian, Registered | Past | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Physical Therapist
- Worcester, MA
- NPI 1295827962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550534400000",
"number": "1144320268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 NEPONSET ST FL STREET2",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016062714",
"telephone_number": "508-368-5532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 NEWTON ST",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721215",
"telephone_number": "508-460-3291",
"fax_number": "508-453-8152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDERICO",
"first_name": "STACEY",
"middle_name": "PANAGOTOPULOS",
"credential": "PHD,RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-25",
"last_updated": "2019-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "RI",
"license": "CDR963741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.