Provider Demographics
NPI:1487538542
Name:PORTWOOD, SHAWN HALTON (RDN)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:HALTON
Last Name:PORTWOOD
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 MARSHALL CT APT 212
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2288
Mailing Address - Country:US
Mailing Address - Phone:413-275-3176
Mailing Address - Fax:
Practice Address - Street 1:2725 MARSHALL CT APT 212
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2288
Practice Address - Country:US
Practice Address - Phone:413-275-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5429-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered