Provider Demographics
NPI:1619745486
Name:LALOR, SHANNON LYNNE (RD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNNE
Last Name:LALOR
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 1:904 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1416
Mailing Address - Country:US
Mailing Address - Phone:765-630-7222
Mailing Address - Fax:765-630-7905
Practice Address - Street 1:90 EXECUTIVE DR STE C
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2612
Practice Address - Country:US
Practice Address - Phone:317-740-1970
Practice Address - Fax:765-630-7905
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003871A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered