Provider Demographics
NPI:1962094904
Name:SHAFRAN, ETHAN (MS, RD)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:SHAFRAN
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SILVERTAIL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-3204
Mailing Address - Country:US
Mailing Address - Phone:845-325-9838
Mailing Address - Fax:
Practice Address - Street 1:8 SILVERTAIL RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-3204
Practice Address - Country:US
Practice Address - Phone:845-325-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered