Provider Demographics
NPI:1750486312
Name:MUGAVERO, SHAUNA CLARK (RD)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:CLARK
Last Name:MUGAVERO
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 1:2150 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-2935
Mailing Address - Fax:717-544-3935
Practice Address - Street 1:2150 HARRISBURG PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-2935
Practice Address - Fax:717-544-3935
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL961082133V00000X
PADN004614133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL961082OtherRD CERTIFICATION NUMBER