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NPI Code Detail

MEDICARE: JDS NUTRITION

MEDICARE: JDS NUTRITION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133VN1004XPediatric Nutrition Registered Dietitian
2133NN1002XNutrition Education Nutritionist
3133VN1101XGerontological Nutrition Registered Dietitian
4133VN1501XSports Dietetics Nutrition Registered Dietitian
5133VN1201XObesity and Weight Management Nutrition Registered Dietitian
6133N00000XNutritionist

General Provider Information

NPI Number : 1952234668
Entity Type Code : Organization
Provider Name (Legal Business Name) : JDS NUTRITION
Provider Business Mailing Address
First Line : 20 SHORE PARK RD
Second Line :
City : GREAT NECK
State : NY
Zip : 11023-2035
Country : US
Telephone Number : 516-423-1110
Fax Number :
Provider Business Practice Location Address
First Line : 3724 30TH ST APT 2C
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-2869
Country : US
Telephone Number : 929-483-4539
Fax Number :
Authorized Official
Title or Position : REGISTERED DIETITIAN NUTRITIONIST
Name : JESSICA SHAMASH
Credential : RDN, CDL, LD
Telephone Number : 516-423-1110
Provider Enumeration Date : 06/04/2026
Last Update Date : 06/04/2026

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