Provider Demographics
NPI:1477902948
Name:MALEEFF, SHANA R (MA, RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:R
Last Name:MALEEFF
Suffix:
Gender:F
Credentials:MA, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WALTER CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3602
Mailing Address - Country:US
Mailing Address - Phone:215-776-0389
Mailing Address - Fax:
Practice Address - Street 1:200 BROADHOLLOW RD
Practice Address - Street 2:STE 207
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4806
Practice Address - Country:US
Practice Address - Phone:215-776-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY916084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered