Provider Demographics
NPI:1932471604
Name:SHUMRAK, JEANNE (MS,RD, LDN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:SHUMRAK
Suffix:
Gender:F
Credentials:MS,RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BURNING TREE RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3237
Mailing Address - Country:US
Mailing Address - Phone:508-653-1442
Mailing Address - Fax:
Practice Address - Street 1:43 BURNING TREE RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3237
Practice Address - Country:US
Practice Address - Phone:508-653-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered