MEDICARE: NATASHA EZIQUIEL-SHRIRO R.D.N.

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	133VN1006X	Metabolic Nutrition Registered Dietitian
2	133V00000X	Registered Dietitian	008918	NY

General Provider Information

NPI Number	:	1760927099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA EZIQUIEL-SHRIRO R.D.N.

Provider Business Mailing Address
First Line	:	8040 COOPER AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7725
Country	:	US
Telephone Number	:	718-887-3090
Fax Number	:	718-326-2656

Provider Business Practice Location Address
First Line	:	8040 COOPER AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7725
Country	:	US
Telephone Number	:	718-887-3090
Fax Number	:	718-326-2656

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

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	04/29/2026

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