Provider Demographics
NPI:1821326042
Name:SHINSTOCK, MICHELLE (RD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:SHINSTOCK
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 1:1442 PASTAL WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6715
Mailing Address - Country:US
Mailing Address - Phone:510-673-4323
Mailing Address - Fax:
Practice Address - Street 1:1442 PASTAL WAY
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6715
Practice Address - Country:US
Practice Address - Phone:510-673-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-29
Last Update Date:2020-02-13
Deactivation Date:2012-12-05
Deactivation Code:
Reactivation Date:2020-02-13
Provider Licenses
StateLicense IDTaxonomies
CA924427133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered