MEDICARE: SHIREEN D DOW RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1019300	WA

General Provider Information

NPI Number	:	1174890040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIREEN D DOW RD

Provider Business Mailing Address
First Line	:	17505 N 79TH AVE
Second Line	:	SUITE 110
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8725
Country	:	US
Telephone Number	:	623-399-6825
Fax Number	:	623-505-3474

Provider Business Practice Location Address
First Line	:	17505 N 79TH AVE
Second Line	:	SUITE 110
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8725
Country	:	US
Telephone Number	:	623-399-6825
Fax Number	:	623-505-3474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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