Provider Demographics
NPI:1205152550
Name:COHEN, ROSE SHELLEY (RD, LDN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:SHELLEY
Last Name:COHEN
Suffix:
Gender:F
Credentials:RD, LDN, IBCLC
Other - Prefix:MISS
Other - First Name:ROSE
Other - Middle Name:SHELLEY
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:240-880-1893
Mailing Address - Fax:240-499-2602
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 220A
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7512
Practice Address - Country:US
Practice Address - Phone:240-880-1893
Practice Address - Fax:301-585-6289
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2793133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered