Provider Demographics
NPI:1548237944
Name:SHAW, KATHERINE M (RD, CDE)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 COLONIAL GREEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-797-0593
Mailing Address - Fax:540-342-4055
Practice Address - Street 1:3501 COLONIAL GREEN CIRCLE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-797-0593
Practice Address - Fax:540-342-4055
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
846139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered