Provider Demographics
NPI:1215038666
Name:SHAPIRO, AMY (RD,CDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PEWTER PL
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5007
Mailing Address - Country:US
Mailing Address - Phone:631-858-0263
Mailing Address - Fax:
Practice Address - Street 1:373 ROUTE 111
Practice Address - Street 2:SUITE 16
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4759
Practice Address - Country:US
Practice Address - Phone:631-979-6699
Practice Address - Fax:631-265-1162
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY138287OtherVYTRA HEALTH PLANS
NY8099809OtherGHI PPO
NY115844POtherHIP
NY2500919 001OtherCIGNA
NYP2399350OtherOXFORD HEALTH PLANS
NY2330023OtherUNITED HEALTHCARE