Elizabeth O Shodimu, LICENSE

Primary specialty

NutritionistTaxonomy code 133N00000X

License

004988-1 Issued in NY

Practice address

110-16 Sutphin Blvd
111-08 Witthoff Street
Queen'S Village, NY 11429

Phone

(917) 658-5068

NPI assigned

Aug 19, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439942400000",
    "number": "1407222920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111-08 WITTHOFF STREET",
            "city": "QUEEN'S VILLAGE",
            "state": "NY",
            "postal_code": "11429",
            "telephone_number": "917-658-5068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110-16 SUTPHIN BLVD",
            "address_2": "111-08 WITTHOFF STREET",
            "city": "QUEEN'S VILLAGE",
            "state": "NY",
            "postal_code": "11429",
            "telephone_number": "917-658-5068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHODIMU",
        "first_name": "ELIZABETH",
        "middle_name": "O",
        "name_prefix": "Ms.",
        "credential": "LICENSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-19",
        "last_updated": "2015-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NY",
            "license": "004988-1",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "004988-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haniel Shen, M.D.
• Suzanne Sher, LMSW
• Diana Shimonova, MS, CCC-SLP
• Esther Su Shin, LAC , ACUPUNCTURE
• Enfu Keith Cabilin Shoda, M.D.
• David Bernard Shoenfeld
• Julia A Shugar, MD
• Nathalie Ann Sicard, NURSE PRACTITIONER
• Donna Siegelstein
• Sigi Therapy Inc.

• Nutritionist in Queen'S Village, NY
• Providers in Queen'S Village, NY by specialty
• Nutritionist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.