MEDICARE: SHARON SARA RAHMANI KALIMI

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	133VN1005X	Renal Nutrition Registered Dietitian	1104898	NY
2	133V00000X	Registered Dietitian	1104899	NY
3	133VN1005X	Renal Nutrition Registered Dietitian	1104899	NY

General Provider Information

NPI Number	:	1689375370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON SARA RAHMANI KALIMI

Provider Business Mailing Address
First Line	:	420 LAKEVILLE RD STE 169
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1121
Country	:	US
Telephone Number	:	516-884-6544
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 LAKEVILLE RD STE 300
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1123
Country	:	US
Telephone Number	:	516-884-6544
Fax Number	:

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

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	08/10/2023

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