Healthcare Provider Details

I. General information

NPI: 1093386260
Provider Name (Legal Business Name): SHIRA D TRATNER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHIRA D GREENFIELD RDN

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 ELRAY DR APT E
BALTIMORE MD
21209-2934
US

IV. Provider business mailing address

6416 ELRAY DR APT E
BALTIMORE MD
21209-2934
US

V. Phone/Fax

Practice location:
  • Phone: 347-668-2487
  • Fax:
Mailing address:
  • Phone: 347-668-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86132358
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86132358
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: