Provider Demographics
NPI:1598195497
Name:HIRSHBERG, SHIRA (RDN)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:HIRSHBERG
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 1:383 W FOUNTAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3515
Mailing Address - Country:US
Mailing Address - Phone:401-617-9485
Mailing Address - Fax:888-317-1148
Practice Address - Street 1:383 W FOUNTAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3515
Practice Address - Country:US
Practice Address - Phone:401-617-9485
Practice Address - Fax:888-317-1148
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3566133V00000X
RILDN00768133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered