MEDICARE: MRS. MARIE SHIMONIAK MS, RD, CNSD

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	851079	CA

General Provider Information

NPI Number	:	1306058367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE SHIMONIAK MS, RD, CNSD

Provider Business Mailing Address
First Line	:	2283 SPRING LAKE DR
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-5452
Country	:	US
Telephone Number	:	925-726-8163
Fax Number	:	925-691-4643

Provider Business Practice Location Address
First Line	:	2283 SPRING LAKE DR
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-5452
Country	:	US
Telephone Number	:	925-726-8163
Fax Number	:	925-691-4643

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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