Provider Demographics
NPI:1134928666
Name:FUNKE, SHANNON ROSE (RD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:FUNKE
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VIA PARAISO
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2541
Mailing Address - Country:US
Mailing Address - Phone:831-402-5452
Mailing Address - Fax:
Practice Address - Street 1:110 VIA PARAISO
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2541
Practice Address - Country:US
Practice Address - Phone:831-402-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered