Provider Demographics
NPI:1063664308
Name:DIMARCO, SHUEFEN C (MPH, RD, CSP, CNSD)
Entity type:Individual
Prefix:MRS
First Name:SHUEFEN
Middle Name:C
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:MPH, RD, CSP, CNSD
Other - Prefix:MRS
Other - First Name:FLORENCE
Other - Middle Name:CHIEN
Other - Last Name:DIMARCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPH, RD, CSP, CNSD
Mailing Address - Street 1:675 WINTERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9202
Mailing Address - Country:US
Mailing Address - Phone:630-361-3674
Mailing Address - Fax:630-357-8412
Practice Address - Street 1:675 WINTERGREEN CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9202
Practice Address - Country:US
Practice Address - Phone:630-361-3674
Practice Address - Fax:630-357-8412
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001121133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric