Provider Demographics
NPI:1033326897
Name:SHANBHAG, RUKHSANA (RD CDE CCN LDN)
Entity Type:Individual
Prefix:MRS
First Name:RUKHSANA
Middle Name:
Last Name:SHANBHAG
Suffix:
Gender:F
Credentials:RD CDE CCN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2540
Mailing Address - Country:US
Mailing Address - Phone:407-671-7123
Mailing Address - Fax:407-645-2779
Practice Address - Street 1:2431 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2540
Practice Address - Country:US
Practice Address - Phone:407-671-7123
Practice Address - Fax:407-645-2779
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered