Provider Demographics
NPI:1912558115
Name:PAUL, SHIRLEY M (RDN, MPH,CDN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:M
Last Name:PAUL
Suffix:
Gender:F
Credentials:RDN, MPH,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BOXWOOD RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1602
Mailing Address - Country:US
Mailing Address - Phone:914-473-8223
Mailing Address - Fax:
Practice Address - Street 1:24 BOXWOOD RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1602
Practice Address - Country:US
Practice Address - Phone:914-473-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered