Real Life Nutrition, Inc.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

846139 Issued in VA

Legal business name

REAL LIFE NUTRITION, INC.

Practice address

5375 Fallowater LN
Roanoke, VA 24018-2401

Phone

(540) 797-0593

NPI assigned

Jul 3, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Katherine M Shaw, R.D., C.D.ENPI 1548237944

Title

Owner

Phone

(540) 797-0593

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katherine M Shaw, RD, CDE

  • Registered Dietitian
  • Roanoke, VA
  • NPI 1548237944

  Dietitian, Registered

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1801825534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 ARLINGTON RD SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240152808",
            "telephone_number": "540-797-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5375 FALLOWATER LN",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240182401",
            "telephone_number": "540-797-0593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REAL LIFE NUTRITION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-797-0593",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.D., C.D.E"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "VA",
            "license": "846139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Registered Dietitian in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; 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.