Active NPI
Taegan Q Gandolfi, RD
- Registered Dietitian
- San Diego, CA
National Provider Identifier
1245958800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86328389
- Practice address
- 625 Broadway
San Diego, CA 92101-5403 - Phone
- (315) 359-8608
- NPI assigned
- Aug 19, 2022
- 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 | 86328389 | NY | Primary |
Addresses
Primary practice location
625 Broadway
San Diego, CA 92101-5403
Mailing address
625 Broadway
San Diego, CA 92101-5403
Phone (585) 922-4020
Other practice location 1
20 Hagen Dr
Rochester, NY 14625-2666
Phone (585) 922-4020 ext. 25822
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 |
|---|---|---|---|
| 86328389 | NY | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Nourish, Inc. | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764028800000",
"number": "1245958800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 BROADWAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921015403",
"telephone_number": "585-922-4020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 BROADWAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921015403",
"telephone_number": "315-359-8608"
}
],
"practiceLocations": [
{
"address_1": "20 Hagen Dr",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "NY",
"postal_code": "146252666",
"country_code": "US",
"telephone_number": "585-922-4020 x25822",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GANDOLFI",
"first_name": "TAEGAN",
"middle_name": "Q",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-19",
"last_updated": "2025-11-25",
"certification_date": "2025-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "86328389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.