Provider Demographics
NPI:1487338729
Name:ROB, SHANITA SHAHREEN (MA, RD, LD)
Entity type:Individual
Prefix:
First Name:SHANITA
Middle Name:SHAHREEN
Last Name:ROB
Suffix:
Gender:F
Credentials:MA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 W ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8737
Mailing Address - Country:US
Mailing Address - Phone:918-829-2119
Mailing Address - Fax:
Practice Address - Street 1:4901 W ELGIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8737
Practice Address - Country:US
Practice Address - Phone:918-829-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86115586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered