Brooke Ann Marie Decelles, MS, RD, CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

010313-01 Issued in NY

Practice address

200 Market Street
Ste 5 PMB 112
Potsdam, NY 13676-1217

Phone

(315) 528-4711

NPI assigned

Jan 3, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Mrs. Brooke Ann Marie Decelles Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nourished Life Nutrition, PLLC

  • Registered Dietitian
  • Liverpool, NY
  • NPI 1891386371

  Dietitian, Registered

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1770171191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MARKET STREET",
            "address_2": "STE 5 PMB 112",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761217",
            "telephone_number": "315-528-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MARKET STREET",
            "address_2": "STE 5 PMB 112",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761217",
            "telephone_number": "315-528-4711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Main Street",
            "address_purpose": "LOCATION",
            "city": "Waddington",
            "state": "NY",
            "postal_code": "13694",
            "country_code": "US",
            "telephone_number": "315-528-4711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Union Place",
            "address_2": "PMB 260",
            "address_purpose": "LOCATION",
            "city": "Summit",
            "state": "NJ",
            "postal_code": "079012563",
            "country_code": "US",
            "telephone_number": "315-528-4711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECELLES",
        "first_name": "BROOKE",
        "middle_name": "ANN MARIE",
        "credential": "MS, RD, CDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-03",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "01031301",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN007980",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "010313-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "DECELLES",
            "middle_name": "ANN MARIE",
            "prefix": "MRS.",
            "credential": "RD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mary-Elizabeth Darrow, RPH
• David M. Hurlbut DDS PLLC
• David McCall MD PC
• Lisa M Davis
• Pota John Davis
• Miranda Lee Deleel, L.P.N.
• Margrethe Frank Demers, MHC
• Jackalyn Despaw
• William J Detorres III, MD
• John C Devine, MD

• Registered Dietitian in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.