Provider Demographics
NPI:1407458698
Name:GRYMES, SHENITA-ANN P (DIETETICS)
Entity Type:Individual
Prefix:
First Name:SHENITA-ANN
Middle Name:P
Last Name:GRYMES
Suffix:
Gender:F
Credentials:DIETETICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 56TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6742
Mailing Address - Country:US
Mailing Address - Phone:202-749-7432
Mailing Address - Fax:
Practice Address - Street 1:269 56TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6742
Practice Address - Country:US
Practice Address - Phone:120-274-9743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty