Healthcare Provider Details

I. General information

NPI: 1205755071
Provider Name (Legal Business Name): SHANNON GRIFFIN RUSSELL RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 COACHMANS WAY
DURHAM NC
27705-6035
US

IV. Provider business mailing address

3231 COACHMANS WAY
DURHAM NC
27705-6035
US

V. Phone/Fax

Practice location:
  • Phone: 910-315-9716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL009729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: