Healthcare Provider Details

I. General information

NPI: 1144036310
Provider Name (Legal Business Name): SHAUNNAN ALLEN COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MISTY MORN LN
HUNTSVILLE AL
35811-8688
US

IV. Provider business mailing address

103 MISTY MORN LN
HUNTSVILLE AL
35811-8688
US

V. Phone/Fax

Practice location:
  • Phone: 256-604-8613
  • Fax:
Mailing address:
  • Phone: 256-604-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number954
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number954
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: