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General NPI Number Information
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NPI Number | 1174598031
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Entity Type | Individual
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Provider Name | RENATA SHILOAH R.D.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 138 MAIN ST # 1013
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1702
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Country | US
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Telephone | 516-343-8745
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Fax | 516-399-5307
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Provider Business Mailing Address
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Address Line | 138 MAIN ST # 1013
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1702
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Country | US
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Telephone | 516-343-8745
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Fax | 516-399-5307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 005678
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License Number State | NY
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