Healthcare Provider Details

I. General information

NPI: 1275919516
Provider Name (Legal Business Name): SHAINA FIMBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 COMMERCE BLVD
STROUDSBURG PA
18360-6214
US

IV. Provider business mailing address

206 E BROWN ST
EAST STROUDSBURG PA
18301-3006
US

V. Phone/Fax

Practice location:
  • Phone: 570-426-2330
  • Fax: 570-426-2331
Mailing address:
  • Phone: 570-426-2330
  • Fax: 570-426-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005468
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: