Provider Demographics
NPI:1932353604
Name:GOLDMAN, SHANA LEE (RD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LEE
Last Name:GOLDMAN
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 1:2366 EASTLAKE AVE E
Mailing Address - Street 2:234
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3366
Mailing Address - Country:US
Mailing Address - Phone:206-898-9369
Mailing Address - Fax:206-428-7108
Practice Address - Street 1:2366 EASTLAKE AVE E
Practice Address - Street 2:234
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3366
Practice Address - Country:US
Practice Address - Phone:206-898-9369
Practice Address - Fax:206-428-7108
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602844175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered