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General NPI Number Information
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NPI Number | 1457168304
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Entity Type | Individual
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Provider Name | ANDRE SHOOK
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Gender | Male
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 2627 HANOVER ST
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City | PALO ALTO
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State | CA
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Zip | 94304-1118
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Country | US
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Telephone | 979-366-3564
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Fax | 870-408-4062
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Provider Business Mailing Address
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Address Line | 1610 S AZURE RIDGE CIR
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City | WASHINGTON
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State | UT
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Zip | 84780-2296
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Country | US
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Telephone | 714-709-1014
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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 | ND14032
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86295452
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License Number State | UT
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