Active NPI
Tish Chambrae Mavigliano, R.D., L.D., CDE
- Registered Dietitian
- Paducah, KY
National Provider Identifier
1356447502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1034
- Practice address
- 6525 U S Highway 60 W
Suite 100
Paducah, KY 42001 - Phone
- (270) 217-9691
- Fax
- (270) 575-9515
- NPI assigned
- Sep 15, 2006
- Last updated
- May 13, 2009
- 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 | 1034 | KY | Primary |
Addresses
Primary practice location
6525 U S Highway 60 W
Suite 100
Paducah, KY 42001
Mailing address
3718 Springdale Cir
Paducah, KY 42001-5244
Phone (270) 217-9691
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1034 | KY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242172800000",
"number": "1356447502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3718 SPRINGDALE CIR",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420015244",
"telephone_number": "270-217-9691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6525 U S HIGHWAY 60 W",
"address_2": "SUITE 100",
"city": "PADUCAH",
"state": "KY",
"postal_code": "42001",
"telephone_number": "270-217-9691",
"fax_number": "270-575-9515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAVIGLIANO",
"first_name": "TISH",
"middle_name": "CHAMBRAE",
"name_prefix": "Mrs.",
"credential": "R.D., L.D., CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2009-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "KY",
"license": "1034",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paducah, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.