Active NPI
Tiffany Lyn Bosiacki, RD, LD
- Registered Dietitian
- Chardon, OH
National Provider Identifier
1760518997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 5565
- Practice address
- 11211 Nicoles Way
Chardon, OH 44024-9383 - Phone
- (440) 479-1552
- NPI assigned
- Feb 23, 2007
- Last updated
- Aug 10, 2015
- 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 | 5565 | OH | Primary |
Addresses
Primary practice location
11211 Nicoles Way
Chardon, OH 44024-9383
Mailing address
11211 Nicoles Way
Chardon, OH 44024-9383
Phone (440) 479-1552
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 |
|---|---|---|---|
| 5565 | OH | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439164800000",
"number": "1760518997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11211 NICOLES WAY",
"city": "CHARDON",
"state": "OH",
"postal_code": "440249383",
"telephone_number": "440-479-1552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11211 NICOLES WAY",
"city": "CHARDON",
"state": "OH",
"postal_code": "440249383",
"telephone_number": "440-479-1552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSIACKI",
"first_name": "TIFFANY",
"middle_name": "LYN",
"credential": "RD, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-23",
"last_updated": "2015-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "5565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chardon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.