Provider Demographics
NPI:1144389784
Name:GUTHRIE, SHANNON TRACY (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:TRACY
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-1650
Mailing Address - Country:US
Mailing Address - Phone:252-269-4198
Mailing Address - Fax:
Practice Address - Street 1:225 BRIDGEWATER DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1650
Practice Address - Country:US
Practice Address - Phone:252-269-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002980133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered