Provider Demographics
NPI:1437560737
Name:OPPENHEIMER, SHIRA (RD)
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:OPPENHEIMER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RIVKA LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4329
Mailing Address - Country:US
Mailing Address - Phone:732-966-2762
Mailing Address - Fax:
Practice Address - Street 1:6 RIVKA LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4329
Practice Address - Country:US
Practice Address - Phone:732-966-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86029262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered