Anika Lynette Avery-Grant – Registered Dietitian

Key facts

NPI: 1508508151
Entity type: Individual (NPI type 1)
Primary specialty: Registered Dietitian 133V00000X
License: LD.3857 (OH)
Practice address: 54 E Colony Dr
Waterville, OH 43566-8723
Phone: (440) 668-1710
NPI assigned: Apr 12, 2022
Sex: Female
Sole proprietor: Yes

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.

Fay Nutrition Registered Dietitian · San Francisco, CA · NPI 1104334465

NPD (past) DIETITIAN, REGISTERED

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Master of Science

State licenses

License	State	Type	Specialty
LD.3857	OH	MD	Registered Dietitian

Practice roles

Organization	Specialty	Status	New patients
Fay Nutrition	Dietitian, Registered	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Registered Dietitian	133V00000X	LD.3857	OH	Yes

Addresses

Primary practice location

54 E Colony Dr
Waterville, OH 43566-8723

Mailing address

2471 Plum Creek LN
Roaming Shores, OH 44084-9687
Phone (440) 668-1710

Other practice location 1

2471 Plum Creek Ln
Roaming Shores, OH 44084-9687
Phone (440) 668-1710

Other providers in Waterville, OH

All providers in Waterville, OH · Registered Dietitian in Ohio

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.