Provider Demographics
NPI:1225293459
Name:SHAVER, DOROTHY S (RD,LD/N)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:S
Last Name:SHAVER
Suffix:
Gender:F
Credentials:RD,LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 WASHINGTON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4217
Mailing Address - Country:US
Mailing Address - Phone:540-815-6937
Mailing Address - Fax:540-563-3630
Practice Address - Street 1:3631 PETERS CREEK RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-2809
Practice Address - Country:US
Practice Address - Phone:540-561-3341
Practice Address - Fax:540-563-3630
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003065133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY2038OtherSTATE
NCL003065OtherSTATE
OHLD6018OtherSTATE
WV677OtherSTATE
TNLDN0000001893OtherSTATE
926124OtherDIETITIAN REGISTRATION - NATIONAL