Provider Demographics
NPI:1528858081
Name:ANDREWS, SHANNON L (RDN/LD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 HIGHWAY 177
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:OK
Mailing Address - Zip Code:74651-0348
Mailing Address - Country:US
Mailing Address - Phone:580-723-4466
Mailing Address - Fax:580-761-1277
Practice Address - Street 1:8151 HIGHWAY 177
Practice Address - Street 2:
Practice Address - City:RED ROCK
Practice Address - State:OK
Practice Address - Zip Code:74651-0348
Practice Address - Country:US
Practice Address - Phone:580-723-4466
Practice Address - Fax:580-761-1277
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1767133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered