Joanna Dicicco, R.D., C.D.E

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86008107 Issued in MI

Practice address

912 S Old Woodward Ave Ste 200
Birmingham, MI 48009-6721

Phone

(248) 631-4756

NPI assigned

Feb 4, 2014

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Joanna Sheill Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 6, 2019.

{
    "created_epoch": "1391472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565049600000",
    "number": "1548683063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 S OLD WOODWARD AVE STE 200",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096721",
            "telephone_number": "248-631-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 S OLD WOODWARD AVE STE 200",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096721",
            "telephone_number": "248-631-4756"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "One Hurley Plaza",
            "address_2": "SON 5th Floor",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485035993",
            "country_code": "US",
            "telephone_number": "810-262-9353",
            "fax_number": "810-760-0440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICICCO",
        "first_name": "JOANNA",
        "credential": "R.D., C.D.E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-04",
        "last_updated": "2019-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MI",
            "license": "86008107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOANNA",
            "last_name": "SHEILL",
            "credential": "RD, CDE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Birmingham, MI
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.