Provider Demographics
NPI:1427405786
Name:CAMMON, SHIEVON L (NUTRITIONIST, MSACN)
Entity Type:Individual
Prefix:MS
First Name:SHIEVON
Middle Name:L
Last Name:CAMMON
Suffix:
Gender:F
Credentials:NUTRITIONIST, MSACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 ADMIRALTY WAY STE 302
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5426
Mailing Address - Country:US
Mailing Address - Phone:310-703-6836
Mailing Address - Fax:
Practice Address - Street 1:4560 ADMIRALTY WAY STE 302
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5426
Practice Address - Country:US
Practice Address - Phone:310-703-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education