Provider Demographics
NPI:1568037125
Name:BRAUNSTEIN, SHANNON KAUFMANN (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAUFMANN
Last Name:BRAUNSTEIN
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 GREEN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1908
Mailing Address - Country:US
Mailing Address - Phone:516-316-3913
Mailing Address - Fax:
Practice Address - Street 1:537 GREEN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1908
Practice Address - Country:US
Practice Address - Phone:516-316-3913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010571133V00000X
NY86119651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered