Active NPI
Gayle Elaine Phaneuf, RD
- Registered Dietitian
- Brockton, MA
National Provider Identifier
1407875917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 514
- Practice address
- 940 Belmont St
Brockton, MA 02301-5596 - Phone
- (774) 826-2059
- NPI assigned
- Jul 18, 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 514 | MA | Primary |
Addresses
Primary practice location
940 Belmont St
Brockton, MA 02301-5596
Mailing address
10 Sherri LN
Acushnet, MA 02743-1414
Phone (508) 971-3791
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 |
|---|---|---|---|
| 514 | MA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687910400000",
"number": "1407875917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 SHERRI LN",
"city": "ACUSHNET",
"state": "MA",
"postal_code": "027431414",
"telephone_number": "508-971-3791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "940 BELMONT ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015596",
"telephone_number": "774-826-2059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHANEUF",
"first_name": "GAYLE",
"middle_name": "ELAINE",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2023-06-28",
"certification_date": "2023-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.