Active NPI
Sissell Gaviola, RDN
- Registered Dietitian
- Woodhaven, NY
National Provider Identifier
1851170013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86167791
- Practice address
- 9124 90TH St
Woodhaven, NY 11421-3017 - Phone
- (347) 922-1126
- NPI assigned
- Sep 27, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86167791 | NY | Primary |
Addresses
Primary practice location
9124 90TH St
Woodhaven, NY 11421-3017
Mailing address
9124 90TH St
Woodhaven, NY 11421-3017
Phone (347) 922-1126
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 |
|---|---|---|---|
| 86167791 | NY | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | 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": "1695772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695772800000",
"number": "1851170013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9124 90TH ST",
"city": "WOODHAVEN",
"state": "NY",
"postal_code": "114213017",
"telephone_number": "347-922-1126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9124 90TH ST",
"city": "WOODHAVEN",
"state": "NY",
"postal_code": "114213017",
"telephone_number": "347-922-1126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIOLA",
"first_name": "SISSELL",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-27",
"last_updated": "2023-09-27",
"certification_date": "2023-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "86167791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodhaven, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.