Provider Demographics
NPI:1619634474
Name:WILLIAMSON, SHANNON LEIGH (RD LDN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1227
Mailing Address - Country:US
Mailing Address - Phone:828-458-8439
Mailing Address - Fax:
Practice Address - Street 1:83 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1227
Practice Address - Country:US
Practice Address - Phone:828-458-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC873898133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC7975901OtherDRIVER'S LICENSE