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Individual

JENNIFER J SHANAHAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
R.D., C.D.N.

Contact information

Practice address
45 RESEARCH WAY, EAST SETAUKET, NY 11733-6401
(631) 941-2000
(631) 941-2010
Mailing address
216 GLEN SUMMER RD, HOLBROOK, NY 11741-5025
(631) 472-6717

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
003715-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0114716
GHI PROVIDER NUMBER
NY
01
2269089
UNITED HC PROVIDER NUMBER
NY
01
7483317
AETNA PROVIDER NUMBER
NY
01
AZ00898
MDNY PROVIDER NUMBER
NY
01
P2640809
OXFORD PROVIDER NUMBER
NY
Enumeration date
11/21/2006
Last updated
07/08/2007
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