Provider Demographics
NPI:1073360715
Name:JOHN, SHRUTHI E (MS, RD)
Entity type:Individual
Prefix:
First Name:SHRUTHI
Middle Name:E
Last Name:JOHN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:SHRUTHI
Other - Middle Name:E
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD
Mailing Address - Street 1:525 SPOTSWOOD GRAVEL HILL RD # 2
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8654
Mailing Address - Country:US
Mailing Address - Phone:732-371-2034
Mailing Address - Fax:
Practice Address - Street 1:542 MASTERSON CT
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1448
Practice Address - Country:US
Practice Address - Phone:732-371-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86058057133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered