Active NPI
Shulamis Rouzaud
- Registered Dietitian
- Great Lakes, IL
National Provider Identifier
1285472423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.009796
- Practice address
- 7102 Illinois St
Great Lakes, IL 60088 - Phone
- (847) 688-7444
- NPI assigned
- Jul 19, 2024
- Last updated
- Jul 19, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.009796 | IL | Primary |
Addresses
Primary practice location
7102 Illinois St
Great Lakes, IL 60088
Mailing address
690 Brittany SQ Apt 1
Grayslake, IL 60030-1359
Phone (773) 396-6907
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 |
|---|---|---|---|
| 164.009796 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721347200000",
"number": "1285472423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "690 BRITTANY SQ APT 1",
"city": "GRAYSLAKE",
"state": "IL",
"postal_code": "600301359",
"telephone_number": "773-396-6907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7102 ILLINOIS ST",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "60088",
"telephone_number": "847-688-7444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUZAUD",
"first_name": "SHULAMIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-19",
"last_updated": "2024-07-19",
"certification_date": "2024-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.009796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.