Provider Demographics
NPI:1386280659
Name:SHAPIRO, JENNIFER (RDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5628
Mailing Address - Country:US
Mailing Address - Phone:410-608-2141
Mailing Address - Fax:
Practice Address - Street 1:5430 CAMPBELL BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-5504
Practice Address - Country:US
Practice Address - Phone:410-933-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009999133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered