MEDICARE: ANNA SHANNON RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86025272	VA

General Provider Information

NPI Number	:	1023558160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA SHANNON RDN

Provider Business Mailing Address
First Line	:	1506 COLONIAL AVE
Second Line	:	APT 1
City	:	NORFOLK
State	:	VA
Zip	:	23517-2064
Country	:	US
Telephone Number	:	757-784-8927
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 COLONIAL AVE
Second Line	:	APT 1
City	:	NORFOLK
State	:	VA
Zip	:	23517-2064
Country	:	US
Telephone Number	:	757-784-8927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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