Provider Demographics
NPI:1225314511
Name:BURKE, STEPHANIE SHANNON (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SHANNON
Last Name:BURKE
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SHANNON
Other - Last Name:MUSILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:1650 RESPONSE ROAD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815
Mailing Address - Country:US
Mailing Address - Phone:916-614-7056
Mailing Address - Fax:
Practice Address - Street 1:1650 RESPONSE ROAD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815
Practice Address - Country:US
Practice Address - Phone:916-614-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered