Provider Demographics
NPI:1326784505
Name:GRANT, SHAUNA (MS, RD)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 N PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1919
Mailing Address - Country:US
Mailing Address - Phone:602-617-4482
Mailing Address - Fax:
Practice Address - Street 1:842 N PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1919
Practice Address - Country:US
Practice Address - Phone:602-617-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1018151133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered