Active NPI
Stephanie Terese Malley, RD
- Registered Dietitian
- Mishawaka, IN
National Provider Identifier
1336467612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 37001711A
- Practice address
- 611 East Douglas Road
Suite 405
Mishawaka, IN 46545-1468 - Phone
- (574) 335-6240
- Fax
- (574) 335-6241
- NPI assigned
- May 11, 2010
- 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 | 37001711A | IN | Primary |
Addresses
Primary practice location
611 East Douglas Road
Suite 405
Mishawaka, IN 46545-1468
Mailing address
611 East Douglas Road
Suite 405
Mishawaka, IN 46545-1468
Phone (574) 335-6240
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 |
|---|---|---|---|
| 37001711A | IN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273536000000",
"number": "1336467612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 EAST DOUGLAS ROAD",
"address_2": "SUITE 405",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451468",
"telephone_number": "574-335-6240",
"fax_number": "574-335-6241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 EAST DOUGLAS ROAD",
"address_2": "SUITE 405",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451468",
"telephone_number": "574-335-6240",
"fax_number": "574-335-6241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLEY",
"first_name": "STEPHANIE",
"middle_name": "TERESE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-11",
"last_updated": "2010-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "37001711A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.