Healthcare Provider Details

I. General information

NPI: 1073344206
Provider Name (Legal Business Name): SHANSHAN ZHOU MS,RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 OXFORD CIR
ORADELL NJ
07649-2425
US

IV. Provider business mailing address

144 OXFORD CIR
ORADELL NJ
07649-2425
US

V. Phone/Fax

Practice location:
  • Phone: 646-330-0458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86033696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: