Provider Demographics
NPI:1164894531
Name:SAFI, SHANON (RD, RDN)
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:
Last Name:SAFI
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 LEHIGH PKWY N
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-2912
Mailing Address - Country:US
Mailing Address - Phone:484-553-7294
Mailing Address - Fax:
Practice Address - Street 1:1521 LEHIGH PKWY N
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-2912
Practice Address - Country:US
Practice Address - Phone:484-553-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005758133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered