Mikaelie Sara Gonzalez, LDN

Key facts

NPI

1386290708

Entity type

Individual (NPI type 1)

Primary specialty

Registered Dietitian 133V00000X

License

DN006853 (PA)

Practice address

292 Saint Charles Way
York, PA 17402-4648

Phone

(717) 851-6231

Fax

(717) 741-1719

NPI assigned

Aug 12, 2019

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 14, 2020.

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1386290708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "292 SAINT CHARLES WAY",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174024648",
            "telephone_number": "717-851-6231",
            "fax_number": "717-741-1719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "MIKAELIE",
        "middle_name": "SARA",
        "credential": "LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-12",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN006853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in York, PA

• Anitha S. Gonsalves, M.D.
• Sarah Gonzaga
• Mark A. Gonzales, D.O.
• Emil David Gonzalez Marrero
• Kaley Elise Gonzalez, MD
• Tana L. Gonzalez, CRNP
• Good Chiropractic, P.C.
• Good Samaritan Physician Services
• Good Samaritan Physician Services
• Good Samaritan Transport Company

All providers in York, PA · Registered Dietitian in Pennsylvania