Provider Demographics
NPI:1760125207
Name:ELSAYED, SHROUK (MS RDN CDN IBCLC)
Entity Type:Individual
Prefix:
First Name:SHROUK
Middle Name:
Last Name:ELSAYED
Suffix:
Gender:F
Credentials:MS RDN CDN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 JOHN ST PH 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2938
Mailing Address - Country:US
Mailing Address - Phone:917-587-2667
Mailing Address - Fax:
Practice Address - Street 1:99 JOHN ST PH 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2938
Practice Address - Country:US
Practice Address - Phone:917-587-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1401XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric Critical Care