Active NPI
Nicole Rose Destefano, RD
- Registered Dietitian
- Middletown, NY
National Provider Identifier
1801651591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 55 Lexington Way
Middletown, NY 10940-1607 - Phone
- (845) 926-7592
- NPI assigned
- Feb 21, 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 | Primary |
Addresses
Primary practice location
55 Lexington Way
Middletown, NY 10940-1607
Mailing address
55 Lexington Way
Middletown, NY 10940-1607
Phone (845) 926-7592
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708473600000",
"number": "1801651591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 LEXINGTON WAY",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109401607",
"telephone_number": "845-926-7592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LEXINGTON WAY",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109401607",
"telephone_number": "845-926-7592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTEFANO",
"first_name": "NICOLE",
"middle_name": "ROSE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-21",
"last_updated": "2024-02-21",
"certification_date": "2024-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middletown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.