Active NPI
Shawn Cooper, REGISTERED DIETITIAN
- Registered Dietitian
- Madison, OH
National Provider Identifier
1437917895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 7714
- Practice address
- 6171 Maxwell Dr
Madison, OH 44057-2068 - Phone
- (440) 417-8418
- NPI assigned
- Mar 11, 2024
- Last updated
- Aug 13, 2024
- Sex
- Male
- 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 | 7714 | OH | Primary |
Addresses
Primary practice location
6171 Maxwell Dr
Madison, OH 44057-2068
Mailing address
6171 Maxwell Dr
Madison, OH 44057-2068
Phone (440) 417-8418
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 |
|---|---|---|---|
| 7714 | OH | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723507200000",
"number": "1437917895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6171 MAXWELL DR",
"city": "MADISON",
"state": "OH",
"postal_code": "440572068",
"telephone_number": "440-417-8418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6171 MAXWELL DR",
"city": "MADISON",
"state": "OH",
"postal_code": "440572068",
"telephone_number": "440-417-8418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "SHAWN",
"credential": "REGISTERED DIETITIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-11",
"last_updated": "2024-08-13",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "7714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.