Provider Demographics
NPI:1235542689
Name:PRADHAN, SHEENA M (RDN)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:M
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528-0599
Mailing Address - Country:US
Mailing Address - Phone:609-375-8064
Mailing Address - Fax:
Practice Address - Street 1:601 RIGHTERS FERRY RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1305
Practice Address - Country:US
Practice Address - Phone:609-375-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008071133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331952Medicare Oscar/Certification
NY00695941Medicaid
NYG100000410Medicare Oscar/Certification