Provider Demographics
NPI:1821198474
Name:SHINODA, EVELYN O (RD)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:O
Last Name:SHINODA
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 1:34492 SALINAS PL
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3308
Mailing Address - Country:US
Mailing Address - Phone:510-797-2402
Mailing Address - Fax:
Practice Address - Street 1:34492 SALINAS PL
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3308
Practice Address - Country:US
Practice Address - Phone:510-797-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420315133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered