Provider Demographics
NPI:1609691211
Name:CROSBY, SHANNON REGINA (MPH, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:REGINA
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5244 S HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-5303
Mailing Address - Country:US
Mailing Address - Phone:417-597-5895
Mailing Address - Fax:
Practice Address - Street 1:5244 S HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-5303
Practice Address - Country:US
Practice Address - Phone:417-597-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011022617133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered