Provider Demographics
NPI:1952769986
Name:FORESTER, SHAVAWN MARIE (PHD RDN)
Entity type:Individual
Prefix:DR
First Name:SHAVAWN
Middle Name:MARIE
Last Name:FORESTER
Suffix:
Gender:F
Credentials:PHD RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10122 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4813
Mailing Address - Country:US
Mailing Address - Phone:916-715-9835
Mailing Address - Fax:
Practice Address - Street 1:10122 VISTA AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4813
Practice Address - Country:US
Practice Address - Phone:916-715-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic