Provider Demographics
NPI:1437917895
Name:COOPER, SHAWN (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 MAXWELL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2068
Mailing Address - Country:US
Mailing Address - Phone:440-417-8418
Mailing Address - Fax:
Practice Address - Street 1:6171 MAXWELL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2068
Practice Address - Country:US
Practice Address - Phone:440-417-8418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7714133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered