Provider Demographics
NPI:1669861555
Name:GENACK, SHOSHANA (RD)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:GENACK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6383 DOUGLAS ST APT 4CW
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1821
Mailing Address - Country:US
Mailing Address - Phone:201-390-1923
Mailing Address - Fax:
Practice Address - Street 1:6383 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1821
Practice Address - Country:US
Practice Address - Phone:201-390-1923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007776-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered