Provider Demographics
NPI:1043589039
Name:QUINN, SHAWN L (RD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:QUINN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9965
Mailing Address - Fax:260-458-5664
Practice Address - Street 1:8028 CARNEGIE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5787
Practice Address - Country:US
Practice Address - Phone:260-373-7872
Practice Address - Fax:260-755-6233
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN37002138A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered