Provider Demographics
NPI:1295375103
Name:SHOEMAKER, VICTORIA (LDN, RDN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:LDN, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 BLACK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-9293
Mailing Address - Country:US
Mailing Address - Phone:817-791-8784
Mailing Address - Fax:937-507-3702
Practice Address - Street 1:629 BLACK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-9293
Practice Address - Country:US
Practice Address - Phone:817-791-8784
Practice Address - Fax:937-507-3702
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered