Provider Demographics
NPI:1124696620
Name:SAUNDERS, SHANNAN (RDN)
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1101
Mailing Address - Country:US
Mailing Address - Phone:908-242-7759
Mailing Address - Fax:
Practice Address - Street 1:365 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1101
Practice Address - Country:US
Practice Address - Phone:908-242-7759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ931804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered