Provider Demographics
NPI:1700342946
Name:SHANDOR, ROSAE CAMARIN (RDN)
Entity Type:Individual
Prefix:MRS
First Name:ROSAE
Middle Name:CAMARIN
Last Name:SHANDOR
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:ROSAE
Other - Middle Name:
Other - Last Name:CALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:116 W CHALAN SANTO PAPA
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910
Mailing Address - Country:US
Mailing Address - Phone:671-479-0055
Mailing Address - Fax:671-477-8300
Practice Address - Street 1:116 W CHALAN SANTO PAPA
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-479-0055
Practice Address - Fax:671-477-8300
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD-33133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered