Healthcare Provider Details

I. General information

NPI: 1912069683
Provider Name (Legal Business Name): SHANA MALONEY R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W MACARTHUR BLVD
OAKLAND CA
94611-5642
US

IV. Provider business mailing address

280 W MACARTHUR BLVD
OAKLAND CA
94611-5642
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1540
  • Fax:
Mailing address:
  • Phone: 510-752-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: