Provider Demographics
NPI:1619637295
Name:WHITTINGHAM, SHANON N (RD/RDN)
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:N
Last Name:WHITTINGHAM
Suffix:
Gender:F
Credentials:RD/RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 LINDEN BLVD STE A2054
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3671
Mailing Address - Country:US
Mailing Address - Phone:347-300-7507
Mailing Address - Fax:
Practice Address - Street 1:751 LINDEN BLVD STE A2054
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3671
Practice Address - Country:US
Practice Address - Phone:347-300-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered