Provider Demographics
NPI:1134944135
Name:FENG, SHIBO (MS, RDN)
Entity type:Individual
Prefix:
First Name:SHIBO
Middle Name:
Last Name:FENG
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VAIL RD APT N8
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1337
Mailing Address - Country:US
Mailing Address - Phone:718-640-0510
Mailing Address - Fax:
Practice Address - Street 1:100 VAIL RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1302
Practice Address - Country:US
Practice Address - Phone:718-640-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86118769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered