Provider Demographics
NPI:1841621976
Name:LEATHERMAN, SHANNON MELISSA (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MELISSA
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MAYFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2623
Mailing Address - Country:US
Mailing Address - Phone:267-221-8377
Mailing Address - Fax:
Practice Address - Street 1:1007 MAYFLOWER DR
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-2623
Practice Address - Country:US
Practice Address - Phone:267-221-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004034133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered