Provider Demographics
NPI:1356050249
Name:MCGOWAN, SHANA DELISE (MS,RDN, LD)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:DELISE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MS,RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 MANCHESTER CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1528
Mailing Address - Country:US
Mailing Address - Phone:832-207-3961
Mailing Address - Fax:
Practice Address - Street 1:2334 MANCHESTER CROSSING DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-1528
Practice Address - Country:US
Practice Address - Phone:832-207-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered