Active NPI
Betsy Ruth Shackelford, RDN
- Registered Dietitian
- Geneva, IL
National Provider Identifier
1669207916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.008341
- Practice address
- 1574 Wesley CT
Geneva, IL 60134-3727 - Phone
- (630) 945-7570
- NPI assigned
- Sep 5, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 164.008341 | IL | Primary |
Addresses
Primary practice location
1574 Wesley CT
Geneva, IL 60134-3727
Mailing address
1574 Wesley CT
Geneva, IL 60134-3727
Phone (630) 945-7570
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.008341 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1669207916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1574 WESLEY CT",
"city": "GENEVA",
"state": "IL",
"postal_code": "601343727",
"telephone_number": "630-945-7570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1574 WESLEY CT",
"city": "GENEVA",
"state": "IL",
"postal_code": "601343727",
"telephone_number": "630-945-7570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELFORD",
"first_name": "BETSY",
"middle_name": "RUTH",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-05",
"last_updated": "2024-09-05",
"certification_date": "2024-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.008341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Geneva, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.