Active NPI
Sharon Denise Jackson, MS RD CDE
- Nutritionist
- Mattapan, MA
National Provider Identifier
1346311008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 1031
- Practice address
- 1425 Blue Hills Ave
Mattapan Community Health Ctr
Mattapan, MA 02126 - Phone
- (617) 898-9052
- Fax
- (617) 713-3438
- NPI assigned
- Nov 13, 2006
- 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 |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 1031 | MA | Primary |
Addresses
Primary practice location
1425 Blue Hills Ave
Mattapan Community Health Ctr
Mattapan, MA 02126
Mailing address
6 Newcroft Circle
Mattapan, MA 02126
Phone (617) 296-3987
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1031 | MA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mattapan Community Health Center Inc | Past | Accepting new patients | |
| Boston University Medical Center Radiologists, Inc. | 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.
-
- Diagnostic Radiology Physician
- Boston, MA
- NPI 1134166945
-
- Federally Qualified Health Center (FQHC)
- Mattapan, MA
- NPI 1639240393
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346311008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 NEWCROFT CIRCLE",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "02126",
"telephone_number": "617-296-3987",
"fax_number": "617-713-3438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 BLUE HILLS AVE",
"address_2": "MATTAPAN COMMUNITY HEALTH CTR",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "02126",
"telephone_number": "617-898-9052",
"fax_number": "617-713-3438"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHARON",
"middle_name": "DENISE",
"name_prefix": "Mrs.",
"credential": "MS RD CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "MA",
"license": "1031",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mattapan, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.