Healthcare Provider Details

I. General information

NPI: 1356649644
Provider Name (Legal Business Name): SHAWN PATRICK TOBIN MA R.D. L.D.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH STREET AND CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA CSH RM 102
PHILADELPHIA PA
19104-0000
US

IV. Provider business mailing address

34TH STREET AND CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA CSH RM 102
PHILADELPHIA PA
19104-0000
US

V. Phone/Fax

Practice location:
  • Phone: 267-426-8784
  • Fax: 215-590-9338
Mailing address:
  • Phone: 267-426-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN002257
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN002257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: