Individual
MS. KAITLYN MARIE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
20325 NORTH 51ST AVENUE, BUILDING 9, SUITE 166, GLENDALE, AZ 85308
(602) 341-5248
(602) 702-5219
Mailing address
20325 NORTH 51ST AVENUE, BUILDING 9, SUITE 166, GLENDALE, AZ 85308
(602) 341-5248
(602) 702-5219
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86085245
AZ
Other
Enumeration date
02/17/2020
Last updated
03/19/2020
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