Basic Information
| Provider Information | |||||||||
| NPI: | 1205345857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANTA | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | PRIYA | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 JOHN ST APT 3B | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100382841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039185828 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 85 JOHN ST APT 3B | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100382841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039185828 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2017 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 009136 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.