Provider Demographics
NPI:1336326925
Name:SHANAMAN, ELIZABETH CHARLOTTE (RD CD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CHARLOTTE
Last Name:SHANAMAN
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4310
Mailing Address - Country:US
Mailing Address - Phone:206-292-2771
Mailing Address - Fax:206-292-3014
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4310
Practice Address - Country:US
Practice Address - Phone:209-292-2771
Practice Address - Fax:206-292-3014
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001955133NN1002X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education