Provider Demographics
NPI:1124775895
Name:SHEA, MARIA (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 WARREN PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3322
Mailing Address - Country:US
Mailing Address - Phone:201-788-2665
Mailing Address - Fax:
Practice Address - Street 1:78 WARREN PL
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3322
Practice Address - Country:US
Practice Address - Phone:201-788-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered