Provider Demographics
NPI:1457421661
Name:SHANNAN CARTER NUTRITION, LLC
Entity Type:Organization
Organization Name:SHANNAN CARTER NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD,CDN
Authorized Official - Phone:646-644-5767
Mailing Address - Street 1:30 W 63RD ST
Mailing Address - Street 2:APT 22L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7103
Mailing Address - Country:US
Mailing Address - Phone:646-644-5767
Mailing Address - Fax:212-247-8093
Practice Address - Street 1:1886 BROADWAY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7033
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:212-247-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004040133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty