Basic Information
| Provider Information | |||||||||
| NPI: | 1063458537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITEMAN | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 677 | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208300677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015701799 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9801 GEORGIA AVE | ||||||||
| Address2: | SUITE 341 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209025276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015928333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | DX2519 | MD | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.