Healthcare Provider Details

I. General information

NPI: 1114092285
Provider Name (Legal Business Name): SHEILA ANN GITTENS RD - CDE - CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY WOODHULL HOSPITAL CENTER DEPARTMENT OF AMBULATORY CARE ROOM #2AB-235
BROOKLYN NY
11206
US

IV. Provider business mailing address

760 BROADWAY - WOODHULL HOSPITAL CENTER DEPARTMENT OF AMBULATORY CARE ROOM #2AB-235'
BROOKLYN NY
11206
US

V. Phone/Fax

Practice location:
  • Phone: 718-724-2421
  • Fax: 718-630-3122
Mailing address:
  • Phone: 718-724-2421
  • Fax: 718-630-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: