Provider Demographics
NPI:1508695628
Name:THAO, SHENG (MS, RDN)
Entity type:Individual
Prefix:
First Name:SHENG
Middle Name:
Last Name:THAO
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 HAWES AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-6206
Mailing Address - Country:US
Mailing Address - Phone:651-200-0213
Mailing Address - Fax:
Practice Address - Street 1:245 HAWES AVE
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-6206
Practice Address - Country:US
Practice Address - Phone:651-200-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered