Individual
SHALONA KATHRYN CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
3830 E VAN BUREN ST, PHOENIX, AZ 85008-6920
(602) 243-7277
Mailing address
3003 N CENTRAL AVE STE 1600, PHOENIX, AZ 85012-2908
(602) 323-3344
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86065124
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405667
—
AZ
Enumeration date
06/19/2018
Last updated
12/20/2018
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