MARY RUSSO NPI 1205922382

NPI Information

  • NPI: 1205922382
  • Provider Name: MARY RUSSO
  • Classification: Dietitian, Registered - 133VN1004X
  • Specialization: Nutrition, Pediatric
  • Entity Type: Individual
  • Address: 750 E ADAMS ST
    SYRACUSE, NY
    ZIP 13210
  • Phone: (315) 464-4220

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NPI Details

Mary Russo is a nutrition and pediatric dietitian registered in Syracuse, NY. The provider is an individual who is a Board Certified Specialist in Pediatric Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition therapy for pediatric patients. Specialists work directly with healthy and/or ill children (newborn up to 21 years of age) as well as children with special health care needs in a variety of settings (hospitals, community-based and/or family-centered programs, education programs, home, etc.), OR indirectly through management, care coordination, education, quality improvement, or research practice linked specifically to pediatric nutrition. Mary Russo NPI is 1205922382. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

750 E ADAMS ST
SYRACUSE, NY
ZIP 13210-306
Phone: (315) 464-4220

The enumeration date for this NPI number is 10/5/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1133VN1004XDietitian, RegisteredNutrition, Pediatric002593-1NEW YORKYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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