MEDICARE: MASHA SHIRKEN DTR

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	133N00000X	Nutritionist		NJ
2	136A00000X	Registered Dietetic Technician	86045947	NJ
3	174H00000X	Health Educator	21667	NY

General Provider Information

NPI Number	:	1881078236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASHA SHIRKEN DTR

Provider Business Mailing Address
First Line	:	26 SIENNA WAY
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2148
Country	:	US
Telephone Number	:	732-979-3487
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 SIENNA WAY
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2148
Country	:	US
Telephone Number	:	732-979-3487
Fax Number	:

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

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	07/15/2015

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Directions to “ MASHA SHIRKEN DTR” Practice Location

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