Provider Demographics
NPI:1073138939
Name:SHANAHAN, KATHRYN JO-ANNE (RDN, RD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JO-ANNE
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:RDN, RD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:SHANAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, RD
Mailing Address - Street 1:4005 41ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5442
Mailing Address - Country:US
Mailing Address - Phone:206-605-4960
Mailing Address - Fax:
Practice Address - Street 1:4005 41ST AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5442
Practice Address - Country:US
Practice Address - Phone:206-605-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered