Provider Demographics
NPI:1750613238
Name:SHAW-SCOTT, BERNADINE L (RD)
Entity type:Individual
Prefix:MS
First Name:BERNADINE
Middle Name:L
Last Name:SHAW-SCOTT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 DREXEL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-3003
Mailing Address - Country:US
Mailing Address - Phone:313-331-4036
Mailing Address - Fax:313-331-4036
Practice Address - Street 1:15126 KERCHEVAL AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1360
Practice Address - Country:US
Practice Address - Phone:313-822-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered