MEDICARE: SHAUN M FOX RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	4923-NU-NU	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4923-NU-NU	OTHER	MA	MASSACHUSETTS DEPARTMENT OF PUBLIC LICENSURE

General Provider Information

NPI Number	:	1215579735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN M FOX RD, LDN

Provider Business Mailing Address
First Line	:	510 NORTH ST STE 6
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4117
Country	:	US
Telephone Number	:	413-445-9243
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 NORTH ST STE 6
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4117
Country	:	US
Telephone Number	:	413-445-9243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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