Provider Demographics
NPI:1790138436
Name:TORAIN, SHANDY (RD)
Entity type:Individual
Prefix:MRS
First Name:SHANDY
Middle Name:
Last Name:TORAIN
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 1:16165 N 83RD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5816
Mailing Address - Country:US
Mailing Address - Phone:510-755-3094
Mailing Address - Fax:
Practice Address - Street 1:14318 W VOLTAIRE ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-6148
Practice Address - Country:US
Practice Address - Phone:510-755-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1056485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790138436Medicaid