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General NPI Number Information
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NPI Number | 1073686796
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Entity Type | Individual
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Provider Name | SHANNON LYN CARROLL R.D.
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2400 SOUTH ST GREATER LAFAYETTE HEALTH SERVICES FOOD AND NUTRITION
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City | LAFAYETTE
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State | IN
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Zip | 47904-3027
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Country | US
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Telephone | 765-449-5139
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Fax | 765-449-3061
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Provider Business Mailing Address
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Address Line | 7392 W DIVISION LINE RD
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City | DELPHI
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State | IN
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Zip | 46923-8909
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Country | US
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Telephone | 765-564-3650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 848411
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License Number State | IN
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