Diane I Bustamante, RD CDN LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

855630 Issued in NY

Practice address

11987 Southern Blvd
Suite 1058
Royal Palm Beach, FL 33411

Phone

(917) 418-5710

NPI assigned

Jan 18, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1558609982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11987 SOUTHERN BLVD",
            "address_2": "SUITE 1058",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "33411",
            "telephone_number": "917-418-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11987 SOUTHERN BLVD",
            "address_2": "SUITE 1058",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "33411",
            "telephone_number": "917-418-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "DIANE",
        "middle_name": "I",
        "name_prefix": "Ms.",
        "credential": "RD CDN LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-18",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "855630",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "005542",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marie Evelyne Buissereth, FNP
• Marcus Burke
• Jenna Burns, PA-C
• Shannon Burt
• Steven J. Bussell, D.M.D.
• Ryan Butz, DPT
• Hannah Lee Buzicky
• Megan L Cabral
• Viviana Sophia Cagnola Flores
• Johanna Calderon, MSN, APRN, FNP-C

• Registered Dietitian in Royal Palm Beach, FL
• Providers in Royal Palm Beach, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.

Verify at the official NPI Registry.