Provider Demographics
NPI:1497456404
Name:TROUT, SHANDI (RDN)
Entity Type:Individual
Prefix:
First Name:SHANDI
Middle Name:
Last Name:TROUT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 E PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5139
Mailing Address - Country:US
Mailing Address - Phone:480-330-8264
Mailing Address - Fax:
Practice Address - Street 1:1845 E PATRICK ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-5139
Practice Address - Country:US
Practice Address - Phone:480-330-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty