Individual
SHANNON MICHELLE SUNDBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CD
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 277-1207
Mailing address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 277-1207
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
3781234901
UT
Other
Enumeration date
08/30/2012
Last updated
08/30/2012
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