Provider Demographics
NPI:1558022921
Name:SCHAPIRO, ILYSE (MS RDN)
Entity Type:Individual
Prefix:
First Name:ILYSE
Middle Name:
Last Name:SCHAPIRO
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 FULTON RD APT 2
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3349
Mailing Address - Country:US
Mailing Address - Phone:917-751-8020
Mailing Address - Fax:
Practice Address - Street 1:500 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1633
Practice Address - Country:US
Practice Address - Phone:917-751-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006382133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered