Provider Demographics
NPI:1235481631
Name:OSHITA, SHAYNA (PHD, RD, LDN)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:OSHITA
Suffix:
Gender:F
Credentials:PHD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W 15TH ST
Mailing Address - Street 2:SUITE R435
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1610
Mailing Address - Country:US
Mailing Address - Phone:773-257-2176
Mailing Address - Fax:773-257-2142
Practice Address - Street 1:2720 W 15TH ST
Practice Address - Street 2:SUITE R435
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1610
Practice Address - Country:US
Practice Address - Phone:773-257-2176
Practice Address - Fax:773-257-2142
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005246133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered