Provider Demographics
NPI:1851720726
Name:SHENKMAN, REBECCA (MPH, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SHENKMAN
Suffix:
Gender:F
Credentials:MPH, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1504
Mailing Address - Country:US
Mailing Address - Phone:973-216-9721
Mailing Address - Fax:
Practice Address - Street 1:146 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1504
Practice Address - Country:US
Practice Address - Phone:973-216-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004668133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered