Healthcare Provider Details

I. General information

NPI: 1184202731
Provider Name (Legal Business Name): SHANNON FALK RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 12/20/2023
Certification Date: 07/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CLEAR SKY WAY
PASADENA MD
21122-7217
US

IV. Provider business mailing address

215 CLEAR SKY WAY
PASADENA MD
21122-7217
US

V. Phone/Fax

Practice location:
  • Phone: 972-632-8045
  • Fax:
Mailing address:
  • Phone: 972-632-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX4784
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: