MEDICARE: MR. SHAWN PATRICK TOBIN MA R.D. L.D.N.

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	DN002257	PA
2	133VN1004X	Pediatric Nutrition Registered Dietitian	DN002257	PA

General Provider Information

NPI Number	:	1356649644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN PATRICK TOBIN MA R.D. L.D.N.

Provider Business Mailing Address
First Line	:	34TH STREET AND CIVIC CENTER BLVD
Second Line	:	CHILDREN'S HOSPITAL OF PHILADELPHIA CSH RM 102
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-0000
Country	:	US
Telephone Number	:	267-426-8784
Fax Number	:

Provider Business Practice Location Address
First Line	:	34TH STREET AND CIVIC CENTER BLVD
Second Line	:	CHILDREN'S HOSPITAL OF PHILADELPHIA CSH RM 102
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-0000
Country	:	US
Telephone Number	:	267-426-8784
Fax Number	:	215-590-9338

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

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/10/2011

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