Active NPI
Greg Samuel Cannon, MS, RD
- Registered Dietitian
- Palm Bay, FL
National Provider Identifier
1740915909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND6331
- Practice address
- 2635 Tepee Ave SE
Palm Bay, FL 32909-7282 - Phone
- (321) 720-8920
- NPI assigned
- Jul 21, 2022
- Sex
- Male
- 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 | ND6331 | FL | Primary |
Addresses
Primary practice location
2635 Tepee Ave SE
Palm Bay, FL 32909-7282
Mailing address
2635 Tepee Ave SE
Palm Bay, FL 32909-7282
Phone (321) 720-8920
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND6331 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1740915909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2635 TEPEE AVE SE",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329097282",
"telephone_number": "321-720-8920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2635 TEPEE AVE SE",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329097282",
"telephone_number": "321-720-8920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "GREG",
"middle_name": "SAMUEL",
"credential": "MS, RD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-21",
"last_updated": "2022-07-21",
"certification_date": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND6331",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Bay, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.