Provider Demographics
NPI:1184862138
Name:BIDINI, SHARLENE R (RD, CSO)
Entity Type:Individual
Prefix:MRS
First Name:SHARLENE
Middle Name:R
Last Name:BIDINI
Suffix:
Gender:F
Credentials:RD, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11417 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4535
Mailing Address - Country:US
Mailing Address - Phone:734-737-0127
Mailing Address - Fax:
Practice Address - Street 1:4900 MERCURY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2947
Practice Address - Country:US
Practice Address - Phone:313-271-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI864559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered