Active NPI
Iman Shalash
- Registered Dietitian
- Lexington, KY
National Provider Identifier
1427629427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 3167 Custer Dr
Lexington, KY 40517-4018 - Phone
- (859) 388-9152
- Fax
- (859) 208-2234
- NPI assigned
- Jul 9, 2021
- 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 | Primary |
Addresses
Primary practice location
3167 Custer Dr
Lexington, KY 40517-4018
Mailing address
3167 Custer Dr
Lexington, KY 40517-4018
Phone (859) 388-9152
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61-1251687 | Medicaid | KY |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625788800000",
"number": "1427629427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3167 CUSTER DR",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405174018",
"telephone_number": "859-388-9152",
"fax_number": "859-208-2234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3167 CUSTER DR",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405174018",
"telephone_number": "859-388-9152",
"fax_number": "859-208-2234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALASH",
"first_name": "IMAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-09",
"last_updated": "2021-07-09",
"certification_date": "2021-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "61-1251687",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.