Provider Demographics
NPI:1275391534
Name:SVIKHART, SHANNON CLAIRE (RD)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:CLAIRE
Last Name:SVIKHART
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 MATTFELDT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3712
Mailing Address - Country:US
Mailing Address - Phone:443-822-9461
Mailing Address - Fax:
Practice Address - Street 1:5603 MATTFELDT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3712
Practice Address - Country:US
Practice Address - Phone:443-822-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6496133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered