Kelly Russo

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

917553 Issued in NY

Practice address

601 Elmwood Ave
Rochester, NY 14642-0001

Phone

(585) 275-2647

NPI assigned

Dec 2, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pediatric G I Nutrition

  • Pediatric Gastroenterology Physician
  • Rochester, NY
  • NPI 1710918305
  Medicare reassignment NPD

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

{
    "created_epoch": "1764633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1275495855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "783 MIDDLEBURY RD",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145802681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-275-2647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-02",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "NY",
            "license": "917553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Nicole Russell, MS, OTR/L
• Nicole Russell, MD
• Anthony Russo
• Emily Victoria Russo, LPN
• Joseph Anthony Russo, PSY.D.
• Kelly Ann Russo
• Kiera O'Connor Russo
• Sarina Russo
• Thomas J Russo, D.O.
• Alana Russotti

• Pediatric Nutrition Registered Dietitian in Rochester, NY
• Providers in Rochester, NY by specialty
• Pediatric Nutrition Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.