Provider Demographics
NPI:1477318590
Name:BURKE, SHANNON (MS RD LDN)
Entity Type:Individual
Prefix:PROF
First Name:SHANNON
Middle Name:
Last Name:BURKE
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 1:31 WHITEHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-2733
Mailing Address - Country:US
Mailing Address - Phone:781-974-3073
Mailing Address - Fax:
Practice Address - Street 1:31 WHITEHEAD AVE
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-2733
Practice Address - Country:US
Practice Address - Phone:781-974-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered