Provider Demographics
NPI:1215377197
Name:SCAFIDI, SHARON R (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:R
Last Name:SCAFIDI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 BIRCHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2258
Mailing Address - Country:US
Mailing Address - Phone:516-931-7350
Mailing Address - Fax:
Practice Address - Street 1:87 BIRCHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2258
Practice Address - Country:US
Practice Address - Phone:516-931-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY974149133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered