Individual
SHANA S TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
104 W 12TH ST STE B, HOUSTON, TX 77008-6990
(713) 868-4372
Mailing address
725 GARDEN OAKS BLVD, HOUSTON, TX 77018-5407
(713) 252-5549
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT85629
TX
Other
Enumeration date
11/08/2018
Last updated
11/08/2018
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