Provider Demographics
NPI:1841391299
Name:MILLIE SHEDORICK, M.S., R.D., INC.
Entity type:Organization
Organization Name:MILLIE SHEDORICK, M.S., R.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEDORICK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:516-797-1366
Mailing Address - Street 1:2412 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5205
Mailing Address - Country:US
Mailing Address - Phone:516-797-1366
Mailing Address - Fax:516-826-6843
Practice Address - Street 1:2412 HUDSON ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-5205
Practice Address - Country:US
Practice Address - Phone:516-797-1366
Practice Address - Fax:516-826-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001141133N00000X, 133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEK061Medicare PIN