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NPI Code Detail

MEDICARE: SHANNON VASILINDA RDN, LDN

MEDICARE: SHANNON VASILINDA RDN, LDN
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
1133V00000XRegistered DietitianL006266NC

General Provider Information

NPI Number : 1023618774
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON VASILINDA RDN, LDN
Provider Business Mailing Address
First Line : 1705 TARBORO ST SW
Second Line :
City : WILSON
State : NC
Zip : 27893-3437
Country : US
Telephone Number : 252-399-8767
Fax Number :
Provider Business Practice Location Address
First Line : 1705 TARBORO ST SW
Second Line :
City : WILSON
State : NC
Zip : 27893-3437
Country : US
Telephone Number : 252-399-8767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2020
Last Update Date : 03/24/2023

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