Provider Demographics
NPI:1619117876
Name:GRAHAM, SHENNA YVONNE (RDN, LMBT)
Entity Type:Individual
Prefix:MISS
First Name:SHENNA
Middle Name:YVONNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RDN, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8731 BRAMPTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215
Mailing Address - Country:US
Mailing Address - Phone:704-806-7510
Mailing Address - Fax:
Practice Address - Street 1:8731 BRAMPTON DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215
Practice Address - Country:US
Practice Address - Phone:704-806-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2019-06-20
Deactivation Date:2012-03-12
Deactivation Code:
Reactivation Date:2016-07-13
Provider Licenses
StateLicense IDTaxonomies
NCL002360133N00000X, 133NN1002X, 133V00000X
NC06188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist