Provider Demographics
NPI:1437865656
Name:SHIN, NAMI (DCN, LDN, CNS)
Entity Type:Individual
Prefix:DR
First Name:NAMI
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:DCN, LDN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 ROUTE 9W # 309
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12493-9800
Mailing Address - Country:US
Mailing Address - Phone:845-594-3697
Mailing Address - Fax:
Practice Address - Street 1:4232 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1766
Practice Address - Country:US
Practice Address - Phone:845-594-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011215-01133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011215-01OtherNYS BOARD OF EDUCATION OFFICE OF PROFESSIONS