Healthcare Provider Details

I. General information

NPI: 1760927099
Provider Name (Legal Business Name): NATASHA EZIQUIEL-SHRIRO R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 COOPER AVE
GLENDALE NY
11385-7725
US

IV. Provider business mailing address

8040 COOPER AVE
GLENDALE NY
11385-7725
US

V. Phone/Fax

Practice location:
  • Phone: 718-887-3090
  • Fax: 718-326-2656
Mailing address:
  • Phone: 718-887-3090
  • Fax: 718-326-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number008918
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: