Healthcare Provider Details

I. General information

NPI: 1952234668
Provider Name (Legal Business Name): JDS NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 30TH ST APT 2C
LONG ISLAND CITY NY
11101-2869
US

IV. Provider business mailing address

20 SHORE PARK RD
GREAT NECK NY
11023-2035
US

V. Phone/Fax

Practice location:
  • Phone: 929-483-4539
  • Fax:
Mailing address:
  • Phone: 516-423-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SHAMASH
Title or Position: REGISTERED DIETITIAN NUTRITIONIST
Credential: RDN, CDL, LD
Phone: 516-423-1110