Lissette Mahoney, RD
Dietitian, Registered in Phoenix, AZ. Individual provider (NPI-1).
NPI number1245950237
StatusActive
Last updated in NPPESMar 24, 2026
Details
- NPI
- 1245950237
- Entity type
- Individual (NPI-1)
- Name
- Lissette Mahoney
- Credential
- RD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 30, 2022
- Certification date
- Mar 24, 2026
- Last updated
- Mar 24, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | 86119382 | AZ | Yes |
Practice location
37429 N 17th AvePhoenix, AZ 85086-7257
Phone 623-262-2218
Mailing address
37429 N 17th AvePhoenix, AZ 85086-7257
Phone 623-262-2218
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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