Provider Demographics
NPI:1043443492
Name:CRANDELL, SHAWN C (RD,CD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:C
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:RD,CD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025
Mailing Address - Country:US
Mailing Address - Phone:812-537-8134
Mailing Address - Fax:812-537-0099
Practice Address - Street 1:600 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2751
Practice Address - Country:US
Practice Address - Phone:812-537-8134
Practice Address - Fax:812-537-0099
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000463A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered