Provider Demographics
NPI:1972237204
Name:SHAKER, KARILYNE RAE (RD, LD)
Entity Type:Individual
Prefix:
First Name:KARILYNE
Middle Name:RAE
Last Name:SHAKER
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 1:1074 E COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1602
Mailing Address - Country:US
Mailing Address - Phone:419-966-4414
Mailing Address - Fax:
Practice Address - Street 1:1074 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-1602
Practice Address - Country:US
Practice Address - Phone:419-966-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered