MEDICARE: ASHLEY SHAW 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

General Provider Information

NPI Number	:	1942898929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SHAW RD, CDN

Provider Business Mailing Address
First Line	:	15 THE PROMENADE
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-4122
Country	:	US
Telephone Number	:	845-642-7494
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 THE PROMENADE
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-4122
Country	:	US
Telephone Number	:	845-642-7494
Fax Number	:

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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