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NPI Code Detail

MEDICARE: SHANNON PICCOLO RD

MEDICARE: SHANNON PICCOLO RD
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 DietitianDX6682MD
2133V00000XRegistered DietitianDI200001674DC

General Provider Information

NPI Number : 1104628528
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON PICCOLO RD
Provider Business Mailing Address
First Line : 3001 PARK CENTER DR APT 409
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-1440
Country : US
Telephone Number : 717-422-3694
Fax Number :
Provider Business Practice Location Address
First Line : 3001 PARK CENTER DR APT 409
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-1440
Country : US
Telephone Number : 717-422-3694
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2025
Last Update Date : 03/26/2025

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Directions to “ SHANNON PICCOLO RD” Practice Location

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