Active NPI
Rebecca Lynn Fuller, RD, CDN
- Registered Dietitian
- Syracuse, NY
National Provider Identifier
1831617646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 009116-1
- Practice address
- 3229 E Genesee St
Syracuse, NY 13214-2016 - Phone
- (917) 455-5513
- NPI assigned
- Aug 31, 2017
- 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 | 009116-1 | NY | Primary |
Addresses
Primary practice location
3229 E Genesee St
Syracuse, NY 13214-2016
Mailing address
410 Rita Dr
Syracuse, NY 13212-2621
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009116-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504137600000",
"number": "1831617646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 RITA DR",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132122621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3229 E GENESEE ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132142016",
"telephone_number": "917-455-5513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "REBECCA",
"middle_name": "LYNN",
"name_prefix": "Miss",
"credential": "RD, CDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-31",
"last_updated": "2017-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "009116-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.