Active NPI
Zachery Shane Johnson, RD
- Registered Dietitian
- Melbourne, FL
National Provider Identifier
1467299693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 11525
- Practice address
- 712 Bonnie Cir
Melbourne, FL 32901-4124 - Phone
- (614) 607-0015
- NPI assigned
- Jul 15, 2024
- Sex
- Male
- 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 | 11525 | FL | Primary |
Addresses
Primary practice location
712 Bonnie Cir
Melbourne, FL 32901-4124
Mailing address
712 Bonnie Cir
Melbourne, FL 32901-4124
Phone (614) 607-0015
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 |
|---|---|---|---|
| 11525 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721001600000",
"number": "1467299693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 BONNIE CIR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329014124",
"telephone_number": "614-607-0015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 BONNIE CIR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329014124",
"telephone_number": "614-607-0015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ZACHERY",
"middle_name": "SHANE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-15",
"last_updated": "2024-07-15",
"certification_date": "2024-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "11525",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.