Provider Demographics
NPI:1710551981
Name:CARRIGAN, SHANNON TERRY (RD/LD ,MS)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:TERRY
Last Name:CARRIGAN
Suffix:
Gender:F
Credentials:RD/LD ,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 EDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:FL
Mailing Address - Zip Code:32189-2116
Mailing Address - Country:US
Mailing Address - Phone:386-327-3287
Mailing Address - Fax:
Practice Address - Street 1:2801 KENNEDY ST
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4150
Practice Address - Country:US
Practice Address - Phone:386-326-3200
Practice Address - Fax:386-326-3399
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3920133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered