Provider Demographics
NPI:1447964788
Name:HERBERT, SHANNON (MS, RDN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 OLD TAPPAN RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6867
Mailing Address - Country:US
Mailing Address - Phone:201-519-4314
Mailing Address - Fax:
Practice Address - Street 1:2 14TH ST APT 905
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6778
Practice Address - Country:US
Practice Address - Phone:201-519-4314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered