Provider Demographics
NPI:1225636046
Name:LEAMAN, SHANNON (MS,RDN, LDN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LEAMAN
Suffix:
Gender:F
Credentials:MS,RDN, LDN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:DOHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LDN
Mailing Address - Street 1:3159 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1243
Mailing Address - Country:US
Mailing Address - Phone:570-617-1138
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006562133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered