Provider Demographics
NPI:1184202731
Name:FALK, SHANNON (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FALK
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CLEAR SKY WAY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7217
Mailing Address - Country:US
Mailing Address - Phone:972-632-8045
Mailing Address - Fax:
Practice Address - Street 1:215 CLEAR SKY WAY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7217
Practice Address - Country:US
Practice Address - Phone:972-632-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
MDDX4784133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist