Provider Demographics
NPI:1407262082
Name:SHENK, JESSICA ANNE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:SHENK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1644
Mailing Address - Country:US
Mailing Address - Phone:215-527-6503
Mailing Address - Fax:
Practice Address - Street 1:5028 MARTIN DR
Practice Address - Street 2:
Practice Address - City:EAST PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1644
Practice Address - Country:US
Practice Address - Phone:215-527-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered