Provider Demographics
NPI:1689991242
Name:LINGG, SHANNON (LD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LINGG
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PHILADELPHIA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1840
Mailing Address - Country:US
Mailing Address - Phone:937-277-8988
Mailing Address - Fax:937-277-9035
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-277-8988
Practice Address - Fax:937-277-9035
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD4809133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered