Provider Demographics
NPI:1023558160
Name:SHANNON, ANNA (RDN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SHANNON
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 1:1506 COLONIAL AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2064
Mailing Address - Country:US
Mailing Address - Phone:757-784-8927
Mailing Address - Fax:
Practice Address - Street 1:1506 COLONIAL AVE
Practice Address - Street 2:APT 1
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2064
Practice Address - Country:US
Practice Address - Phone:757-784-8927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86025272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered