Active NPI
Sonja Mydels, R.D.
- Registered Dietitian
- Roseville, MN
National Provider Identifier
1316482649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 3805
- Practice address
- 2800 Cleveland Ave N
Roseville, MN 55113-1126 - Phone
- (651) 789-3274
- NPI assigned
- Dec 22, 2016
- Last updated
- Apr 13, 2018
- 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 | 3805 | MN | Primary |
Addresses
Primary practice location
2800 Cleveland Ave N
Roseville, MN 55113-1126
Mailing address
3409 Bryant Ave S
Minneapolis, MN 55408-4111
Phone (612) 458-9292
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1562 | Other | COLLEGE OF DIETITIANS OF BRITISH COLUMBIA |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523577600000",
"number": "1316482649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3409 BRYANT AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554084111",
"telephone_number": "612-458-9292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 CLEVELAND AVE N",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551131126",
"telephone_number": "651-789-3274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYDELS",
"first_name": "SONJA",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-22",
"last_updated": "2018-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "3805",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLLEGE OF DIETITIANS OF BRITISH COLUMBIA",
"identifier": "1562",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.