Healthcare Provider Details

I. General information

NPI: 1902581986
Provider Name (Legal Business Name): SHAUNA TAVCAR RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3732 LAKESIDE DR STE 200
RENO NV
89509-4519
US

IV. Provider business mailing address

6067 WHITE WATER WAY
RENO NV
89523-1731
US

V. Phone/Fax

Practice location:
  • Phone: 775-360-6500
  • Fax:
Mailing address:
  • Phone: 775-240-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number40628-DI-0
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: