Provider Demographics
NPI:1619413457
Name:SHURPIN, MIRIAM (RDN CDN)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:SHURPIN
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 1:9 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2824
Mailing Address - Country:US
Mailing Address - Phone:347-525-8829
Mailing Address - Fax:
Practice Address - Street 1:9 EMERALD DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2824
Practice Address - Country:US
Practice Address - Phone:347-525-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008807133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered