Active NPI
Jacqueline Ann Justice, M.S., C.N.S.
- Nutritionist
- Stamford, CT
National Provider Identifier
1821147604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 004970
- Practice address
- 112 Southfield Ave Apt 408
408
Stamford, CT 06902-7662 - Phone
- (914) 274-0932
- NPI assigned
- Jan 9, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 001754 | CT | |
| Nutritionist | 133N00000X | 004970 | NY | Primary |
Addresses
Primary practice location
112 Southfield Ave Apt 408
408
Stamford, CT 06902-7662
Mailing address
112 Southfield Ave Apt 408
408
Stamford, CT 06902-7662
Phone (914) 274-0932
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
- Credentials
- Certified Nurse Specialist, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001754 | CT | MD | Nutritionist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Federation Employment and Guidance Service, Inc | 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.
-
- Developmental Disabilities Clinic/Center
- New York, NY
- NPI 1942243084
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772236800000",
"number": "1821147604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 SOUTHFIELD AVE APT 408",
"address_2": "408",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069027662",
"telephone_number": "914-274-0932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 SOUTHFIELD AVE APT 408",
"address_2": "408",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069027662",
"telephone_number": "914-274-0932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUSTICE",
"first_name": "JACQUELINE",
"middle_name": "ANN",
"credential": "M.S., C.N.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2026-02-28",
"certification_date": "2026-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "CT",
"license": "001754",
"primary": false
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "NY",
"license": "004970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stamford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.