Provider Demographics
NPI:1609265479
Name:POWERS-JONES, SHANNON (RD, LDN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:POWERS-JONES
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 BENTGRASS LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8537
Mailing Address - Country:US
Mailing Address - Phone:803-396-0935
Mailing Address - Fax:
Practice Address - Street 1:1743 BENTGRASS LN
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-8537
Practice Address - Country:US
Practice Address - Phone:803-396-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004175133V00000X
SC1289133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered