Active NPI
Simone E Nicolas, RDN CDN
- Registered Dietitian
- Valley Stream, NY
National Provider Identifier
1194020933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 48 0066642
- Practice address
- 1108 Marc Dr
Valley Stream, NY 11581-2536 - Phone
- (516) 837-7554
- NPI assigned
- Jan 25, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 48 0066642 | NY | Primary |
| Nutrition Education Nutritionist | 133NN1002X | 48 006642 | NY |
Addresses
Primary practice location
1108 Marc Dr
Valley Stream, NY 11581-2536
Mailing address
1108 Marc Dr
Valley Stream, NY 11581-2536
Phone (516) 837-7554
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
| License | State | Type | Specialty |
|---|---|---|---|
| 48 006642 | NY | MD | Nutrition Education Nutritionist |
| 48 0066642 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701129600000",
"number": "1194020933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1108 MARC DR",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115812536",
"telephone_number": "516-837-7554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1108 MARC DR",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115812536",
"telephone_number": "516-837-7554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLAS",
"first_name": "SIMONE",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "RDN CDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-25",
"last_updated": "2023-11-28",
"certification_date": "2023-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "48 0066642",
"primary": true
},
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "NY",
"license": "48 006642",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.