Healthcare Provider Details

I. General information

NPI: 1740525328
Provider Name (Legal Business Name): NADIA M AL-SHAFEI R.D., C.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 EMMONS AVE
BROOKLYN NY
11235-2727
US

IV. Provider business mailing address

2211 EMMONS AVE
BROOKLYN NY
11235-2727
US

V. Phone/Fax

Practice location:
  • Phone: 718-368-2960
  • Fax: 718-368-2249
Mailing address:
  • Phone: 718-368-2960
  • Fax: 718-368-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number007624
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: