Provider Demographics
NPI:1508091455
Name:LEVINSKY, SHANNON (RD,LD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LEVINSKY
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 WINFREE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5555
Mailing Address - Country:US
Mailing Address - Phone:863-686-0781
Mailing Address - Fax:
Practice Address - Street 1:1745 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3016
Practice Address - Country:US
Practice Address - Phone:863-688-0576
Practice Address - Fax:863-688-5907
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2615133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered