MEDICARE: MS. SHANA R MALEEFF MA, RD, CDN

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	916084	NY

General Provider Information

NPI Number	:	1477902948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANA R MALEEFF MA, RD, CDN

Provider Business Mailing Address
First Line	:	30 WALTER CT
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-3602
Country	:	US
Telephone Number	:	215-776-0389
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BROADHOLLOW RD
Second Line	:	STE 207
City	:	MELVILLE
State	:	NY
Zip	:	11747-4806
Country	:	US
Telephone Number	:	215-776-0389
Fax Number	:

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	05/17/2021

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