Provider Demographics
NPI:1821743972
Name:HERNANDEZ, SHANDRA RENEE (RD,LD)
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:RENEE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 HEMINGWAY PASS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4526
Mailing Address - Country:US
Mailing Address - Phone:817-597-8788
Mailing Address - Fax:
Practice Address - Street 1:4116 HEMINGWAY PASS LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4526
Practice Address - Country:US
Practice Address - Phone:817-597-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered