Provider Demographics
NPI:1376380584
Name:SOLOMON, SHANNON LEA (RD)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEA
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 PASEO DE LEON
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4915
Mailing Address - Country:US
Mailing Address - Phone:415-609-0319
Mailing Address - Fax:
Practice Address - Street 1:716 PASEO DE LEON
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4915
Practice Address - Country:US
Practice Address - Phone:415-609-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA886369133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered