Active NPI
Mary Jo Hanna Farrelly, RD, CDE
- Registered Dietitian
- Bridgeport, CT
National Provider Identifier
1679757900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 267 Grant St
Diabetes Education Center
Bridgeport, CT 06610-5000 - Phone
- (203) 336-7305
- Fax
- (203) 384-4274
- NPI assigned
- Dec 21, 2007
- 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 | Primary |
Addresses
Primary practice location
267 Grant St
Diabetes Education Center
Bridgeport, CT 06610-5000
Mailing address
267 Grant St
Diabetes Education Center
Bridgeport, CT 06610-5000
Phone (203) 336-7305
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198195200000",
"number": "1679757900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "267 GRANT ST",
"address_2": "DIABETES EDUCATION CENTER",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066105000",
"telephone_number": "203-336-7305",
"fax_number": "203-384-4274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "267 GRANT ST",
"address_2": "DIABETES EDUCATION CENTER",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066105000",
"telephone_number": "203-336-7305",
"fax_number": "203-384-4274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARRELLY",
"first_name": "MARY JO",
"middle_name": "HANNA",
"name_prefix": "Mrs.",
"credential": "RD, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-21",
"last_updated": "2007-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.