Healthcare Provider Details

I. General information

NPI: 1922911411
Provider Name (Legal Business Name): SHANNON MENDEZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 N 15TH ST
SAN JOSE CA
95112-1726
US

IV. Provider business mailing address

461 N 15TH ST
SAN JOSE CA
95112-1726
US

V. Phone/Fax

Practice location:
  • Phone: 408-608-4175
  • Fax:
Mailing address:
  • Phone: 408-608-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: