Provider Demographics
NPI:1790222560
Name:SHAPIRO, RENA P (RD)
Entity Type:Individual
Prefix:MRS
First Name:RENA
Middle Name:P
Last Name:SHAPIRO
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 1:700 COLUMBUS AVENUE
Mailing Address - Street 2:APT 18C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6662
Mailing Address - Country:US
Mailing Address - Phone:917-575-7246
Mailing Address - Fax:
Practice Address - Street 1:700 COLUMBUS AVE
Practice Address - Street 2:APT 18C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6662
Practice Address - Country:US
Practice Address - Phone:917-575-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY837617133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered