Active NPI
Dane Shearer, CPT, CMES, LWMC
- Registered Dietitian
- East Stroudsburg, PA
National Provider Identifier
1821433616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86078718
- Practice address
- 2313 Snapdragon PT
East Stroudsburg, PA 18301-9397 - Phone
- (843) 860-3064
- NPI assigned
- May 7, 2013
- Sex
- Male
- 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 | 86078718 | NY | Primary |
Addresses
Primary practice location
2313 Snapdragon PT
East Stroudsburg, PA 18301-9397
Mailing address
10460 Queens Blvd Apt 15C
Forest Hills, NY 11375-7309
Phone (843) 860-3064
Other practice location 1
10406 Metropolitan Ave
Forest Hills, NY 11375-6736
Phone (718) 577-1388
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240617002075 | PA | Practitioner - Registered Dietitian Or Nutrition Professional | 5193078954 | Practice locations: East Stroudsburg, PA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86078718 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1821433616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10460 QUEENS BLVD APT 15C",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113757309",
"telephone_number": "843-860-3064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2313 SNAPDRAGON PT",
"city": "EAST STROUDSBURG",
"state": "PA",
"postal_code": "183019397",
"telephone_number": "843-860-3064"
}
],
"practiceLocations": [
{
"address_1": "10406 Metropolitan Ave",
"address_purpose": "LOCATION",
"city": "Forest Hills",
"state": "NY",
"postal_code": "113756736",
"country_code": "US",
"telephone_number": "718-577-1388",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHEARER",
"first_name": "DANE",
"credential": "CPT, CMES, LWMC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-05-07",
"last_updated": "2022-07-05",
"certification_date": "2022-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "86078718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Stroudsburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.