Active NPI
Joseph Shepherd, MS, RD/LD
- Registered Dietitian
- Fort Drum, NY
National Provider Identifier
1184182081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2380
- Practice address
- 11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438 - Phone
- (405) 269-3154
- NPI assigned
- Mar 10, 2019
- Last updated
- Nov 11, 2022
- Sex
- Male
- 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 | 2380 | OK | Primary |
Addresses
Primary practice location
11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Mailing address
10728 Harris Rd
Carthage, NY 13619-8594
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2380 | OK | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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": "1552176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668124800000",
"number": "1184182081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10728 HARRIS RD",
"city": "CARTHAGE",
"state": "NY",
"postal_code": "136198594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11050 MOUNT BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025438",
"telephone_number": "405-269-3154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "JOSEPH",
"credential": "MS, RD/LD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-10",
"last_updated": "2022-11-11",
"certification_date": "2022-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "2380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Drum, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.