Marisa Peruso, RDN,LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DN006331 Issued in PA

Practice address

118 Shaeli Dr
Somerset, PA 15501-1805

Phone

(814) 443-0158

NPI assigned

Oct 5, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Marisa Peruso Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1962127696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 SHAELI DR",
            "city": "SOMERSET",
            "state": "PA",
            "postal_code": "155011805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 SHAELI DR",
            "city": "SOMERSET",
            "state": "PA",
            "postal_code": "155011805",
            "telephone_number": "814-443-0158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERUSO",
        "first_name": "MARISA",
        "credential": "RDN,LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-05",
        "last_updated": "2022-10-05",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN006331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DN006331",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "PERUSO",
            "credential": "RDN,LDN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Dietitian in Somerset, PA
• Providers in Somerset, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.