Basic Information
| Provider Information | |||||||||
| NPI: | 1174598031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHILOAH | ||||||||
| FirstName: | RENATA | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 ROCKAWAY TPKE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115591216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163745024 | ||||||||
| FaxNumber: | 5163745816 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 ROCKAWAY TPKE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115591216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163745024 | ||||||||
| FaxNumber: | 5163745816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1006X | 005678 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
No ID Information.