MEDICARE: SHOSHANA GENACK 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	007776-1	NY

General Provider Information

NPI Number	:	1669861555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOSHANA GENACK RD

Provider Business Mailing Address
First Line	:	6383 DOUGLAS ST APT 4CW
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1821
Country	:	US
Telephone Number	:	201-390-1923
Fax Number	:

Provider Business Practice Location Address
First Line	:	6383 DOUGLAS ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1821
Country	:	US
Telephone Number	:	201-390-1923
Fax Number	:

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

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	08/30/2022

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Directions to “ SHOSHANA GENACK RD” Practice Location

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