Corey Ann-Buell Shack, R.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1061420 Issued in MI

Practice address

1717 Shaffer St Ste 124
Kalamazoo, MI 49048-1629

Phone

(269) 226-4909

NPI assigned

Feb 18, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1361145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1588904254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 GULL RD",
            "address_2": "BORGESS MEDICAL CENTER",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 SHAFFER ST STE 124",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481629",
            "telephone_number": "269-226-4909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1521 Gull Rd",
            "address_2": "Borgess Medical Center",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490481640",
            "country_code": "US",
            "telephone_number": "269-226-4909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHACK",
        "first_name": "COREY",
        "middle_name": "ANN-BUELL",
        "name_prefix": "Mrs.",
        "credential": "R.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-18",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MI",
            "license": "1061420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Michelle Setzer, DO
• Mary Severe, LMSW
• Rachel Ann Sexton
• Sahar Seyedin, PHARMD
• Ailia Shaak
• Nourhan Gamal Bayoumy Shafeey, M.B.B.CH
• Elizabeth Jane Shafer, OTRL
• Gigi Shafer, MD
• Christine Shaffer
• Dianne Shaffer, LMSW

• Registered Dietitian in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.