MEDICARE: SHANNON L ANDREWS RDN/LD

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	1767	OK

General Provider Information

NPI Number	:	1528858081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON L ANDREWS RDN/LD

Provider Business Mailing Address
First Line	:	8151 HIGHWAY 177
Second Line	:
City	:	RED ROCK
State	:	OK
Zip	:	74651-0348
Country	:	US
Telephone Number	:	580-723-4466
Fax Number	:	580-761-1277

Provider Business Practice Location Address
First Line	:	8151 HIGHWAY 177
Second Line	:
City	:	RED ROCK
State	:	OK
Zip	:	74651-0348
Country	:	US
Telephone Number	:	580-723-4466
Fax Number	:	580-761-1277

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

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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