Provider Demographics
NPI:1366288987
Name:SHUBA, ANASTASSIYA (MS,RD,LDN)
Entity type:Individual
Prefix:
First Name:ANASTASSIYA
Middle Name:
Last Name:SHUBA
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NE 22ND ST APT 506
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5182
Mailing Address - Country:US
Mailing Address - Phone:305-853-6656
Mailing Address - Fax:
Practice Address - Street 1:425 NE 22ND ST APT 506
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5182
Practice Address - Country:US
Practice Address - Phone:305-853-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND13156133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered