Provider Demographics
NPI:1487665352
Name:CARTER, SHANNAN E (MS,RD,CDN)
Entity Type:Individual
Prefix:MISS
First Name:SHANNAN
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS,RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 63RD ST
Mailing Address - Street 2:22L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7103
Mailing Address - Country:US
Mailing Address - Phone:646-644-5767
Mailing Address - Fax:212-247-8093
Practice Address - Street 1:1886 BROADWAY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7033
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:212-247-8093
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004040133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered