Provider Demographics
NPI:1659725802
Name:MCCARTY, SHATONIA (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:SHATONIA
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 HIGHWAY 90 E TRLR 218
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70615-4769
Mailing Address - Country:US
Mailing Address - Phone:337-794-3464
Mailing Address - Fax:
Practice Address - Street 1:6675 HIGHWAY 90 E TRLR 218
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-4769
Practice Address - Country:US
Practice Address - Phone:337-794-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA819347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered