Provider Demographics
NPI:1417796061
Name:GROSS, SHAINA DAVIS (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:DAVIS
Last Name:GROSS
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICKAMAUGA
Mailing Address - State:GA
Mailing Address - Zip Code:30707-1641
Mailing Address - Country:US
Mailing Address - Phone:423-645-5708
Mailing Address - Fax:
Practice Address - Street 1:121 HUNTER DR
Practice Address - Street 2:
Practice Address - City:CHICKAMAUGA
Practice Address - State:GA
Practice Address - Zip Code:30707-1641
Practice Address - Country:US
Practice Address - Phone:423-645-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered