Provider Demographics
NPI:1881304616
Name:SHAWHAN, STACY (RD, CSO, LD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SHAWHAN
Suffix:
Gender:F
Credentials:RD, CSO, LD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:HOLDEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CSO, LD
Mailing Address - Street 1:4013 TAMWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2346
Mailing Address - Country:US
Mailing Address - Phone:513-482-0994
Mailing Address - Fax:
Practice Address - Street 1:3151 BELLEVUE AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-584-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology