Provider Demographics
NPI:1437475571
Name:FEENEY, MARY SHANNON (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SHANNON
Last Name:FEENEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1631
Mailing Address - Country:US
Mailing Address - Phone:570-340-2378
Mailing Address - Fax:570-207-4123
Practice Address - Street 1:640 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1631
Practice Address - Country:US
Practice Address - Phone:570-340-2378
Practice Address - Fax:570-207-4123
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004339133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered