Provider Demographics
NPI:1801926167
Name:DOUGHERTY, SHANNON MARIE (RD)
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:MARIE
Last Name:DOUGHERTY
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 1:66 EUSTON RD S
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3901
Mailing Address - Country:US
Mailing Address - Phone:267-767-6710
Mailing Address - Fax:800-349-2164
Practice Address - Street 1:66 EUSTON RD S
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3901
Practice Address - Country:US
Practice Address - Phone:267-767-6710
Practice Address - Fax:800-349-2164
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered