Provider Demographics
NPI:1770644056
Name:JORDAN, SHANNON MELISSA (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MELISSA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LAWRENCE EXPY
Mailing Address - Street 2:2ND FLOOR, DEPT 282
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:408-851-2429
Mailing Address - Fax:408-851-2599
Practice Address - Street 1:710 LAWRENCE EXPY
Practice Address - Street 2:2ND FLOOR, DEPT 282
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-2429
Practice Address - Fax:408-851-2599
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered