Active NPI
Dipti V Shah, R.D.
- Registered Dietitian
- Wheaton, IL
National Provider Identifier
1609123488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.005638
- Practice address
- 104 E Roosevelt Rd
Ste 201
Wheaton, IL 60187-5267 - Phone
- (630) 752-8823
- NPI assigned
- Aug 10, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | 164.005638 | IL | Primary |
Addresses
Primary practice location
104 E Roosevelt Rd
Ste 201
Wheaton, IL 60187-5267
Mailing address
104 E Roosevelt Rd
Ste 201
Wheaton, IL 60187-5267
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164.005638 | Other | IL | LICENSE # |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.005638 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351468800000",
"number": "1609123488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 E ROOSEVELT RD",
"address_2": "STE 201",
"city": "WHEATON",
"state": "IL",
"postal_code": "601875267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 E ROOSEVELT RD",
"address_2": "STE 201",
"city": "WHEATON",
"state": "IL",
"postal_code": "601875267",
"telephone_number": "630-752-8823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "DIPTI",
"middle_name": "V",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-10",
"last_updated": "2012-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.005638",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "164.005638",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.