Provider Demographics
NPI:1194611996
Name:PUJOL, SHANNON EVINS
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:EVINS
Last Name:PUJOL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:MCCARTNEY
Other - Last Name:EVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9510 WEXCROFT DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9510 WEXCROFT DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3823
Practice Address - Country:US
Practice Address - Phone:615-438-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5169133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered