Provider Demographics
NPI:1588041032
Name:FROST, SHAYNA (RD)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 25TH ST NW
Mailing Address - Street 2:APARTMENT 602
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2104
Mailing Address - Country:US
Mailing Address - Phone:610-304-0787
Mailing Address - Fax:
Practice Address - Street 1:925 25TH ST NW
Practice Address - Street 2:APARTMENT 602
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2104
Practice Address - Country:US
Practice Address - Phone:610-304-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3677133VN1006X
DCDI100000832133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6840221Medicaid