Provider Demographics
NPI:1033242136
Name:SHAPERA, MERLE ROSE (MS,RD,CDE,LD)
Entity Type:Individual
Prefix:MS
First Name:MERLE
Middle Name:ROSE
Last Name:SHAPERA
Suffix:
Gender:F
Credentials:MS,RD,CDE,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1572 MAPLE AVENUE
Mailing Address - Street 2:UNIT 604
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:708-415-2693
Mailing Address - Fax:708-763-1014
Practice Address - Street 1:1572 MAPLE AVENUE
Practice Address - Street 2:UNIT 604
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:708-415-2693
Practice Address - Fax:708-763-1014
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164000616133V00000X
IL164.000616133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164.000616OtherIL STATENUTRITION LICENSE