Provider Demographics
NPI:1669456083
Name:ANTIN-KANTROWITZ, SHARON M (MS RD CDN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:M
Last Name:ANTIN-KANTROWITZ
Suffix:
Gender:
Credentials:MS RD CDN
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:M
Other - Last Name:ANTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSRDCDN
Mailing Address - Street 1:39 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1312
Mailing Address - Country:US
Mailing Address - Phone:516-766-2514
Mailing Address - Fax:
Practice Address - Street 1:39 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1312
Practice Address - Country:US
Practice Address - Phone:516-208-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 133V00000X
NY005096133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9217E1Medicare ID - Type Unspecified
P48095Medicare UPIN