Active NPI
Shelby Lynn Dederick, RD/LD
- Registered Dietitian
- Tulsa, OK
National Provider Identifier
1346558616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1533
- Practice address
- 4304 E 52ND PL
Tulsa, OK 74135-3915 - Phone
- (785) 554-2497
- NPI assigned
- Sep 20, 2010
- Last updated
- Sep 20, 2010
- 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 | 1533 | OK | Primary |
Addresses
Primary practice location
4304 E 52ND PL
Tulsa, OK 74135-3915
Mailing address
4304 E 52ND PL
Tulsa, OK 74135-3915
Phone (785) 554-2497
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 |
|---|---|---|---|
| 1533 | OK | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284940800000",
"number": "1346558616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4304 E 52ND PL",
"city": "TULSA",
"state": "OK",
"postal_code": "741353915",
"telephone_number": "785-554-2497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4304 E 52ND PL",
"city": "TULSA",
"state": "OK",
"postal_code": "741353915",
"telephone_number": "785-554-2497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDERICK",
"first_name": "SHELBY",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "RD/LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-20",
"last_updated": "2010-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "1533",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.