Provider Demographics
NPI:1235435538
Name:WEINSTOCK, SHELLEY BETH (PHD, CNS)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:BETH
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:PHD, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 MILLBURN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3714
Mailing Address - Country:US
Mailing Address - Phone:973-477-6985
Mailing Address - Fax:
Practice Address - Street 1:2115 MILLBURN AVE STE 101
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3714
Practice Address - Country:US
Practice Address - Phone:973-477-6985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist