Provider Demographics
NPI:1801016662
Name:SHEYMAN, MARINA L (MSRD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:L
Last Name:SHEYMAN
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30500 NORTHWESTERN HWY # 316C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3159
Mailing Address - Country:US
Mailing Address - Phone:248-539-8897
Mailing Address - Fax:248-539-8940
Practice Address - Street 1:30500 NORTHWESTERN HWY # 316C
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3159
Practice Address - Country:US
Practice Address - Phone:248-539-8897
Practice Address - Fax:248-539-8940
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00960888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered