Provider Demographics
NPI:1902561327
Name:SHATKIN, DANIELLE JADE (RD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JADE
Last Name:SHATKIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ROCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2515
Mailing Address - Country:US
Mailing Address - Phone:716-609-9411
Mailing Address - Fax:
Practice Address - Street 1:333 ROCKINGHAM ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2515
Practice Address - Country:US
Practice Address - Phone:716-609-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered