MEDICARE: SHIRLEY JUE SONG RDN, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	013293	NY

General Provider Information

NPI Number	:	1588518625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY JUE SONG RDN, CDN

Provider Business Mailing Address
First Line	:	229 E 110TH ST APT 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-3368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 E 110TH ST APT 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-3368
Country	:	US
Telephone Number	:	562-299-8030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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