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General NPI Number Information
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NPI Number | 1336039155
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Entity Type | Individual
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Provider Name | SHANA PETIT MS RDN
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Gender | Female
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 282 WASHINGTON ST
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City | HARTFORD
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State | CT
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Zip | 06106-3322
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Country | US
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Telephone | 860-545-8847
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Fax |
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Provider Business Mailing Address
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Address Line | 5 FAVORITE LN
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-3199
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Country | US
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Telephone | 860-305-8913
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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 | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | 002074
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License Number State | CT
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