Provider Demographics
NPI:1679360325
Name:MILLER LEHMAN, SHANNON (RDN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MILLER LEHMAN
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 1:51 YACHT CLUB DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4440
Mailing Address - Country:US
Mailing Address - Phone:803-238-3863
Mailing Address - Fax:
Practice Address - Street 1:51 YACHT CLUB DR NE STE A
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4440
Practice Address - Country:US
Practice Address - Phone:803-238-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012140-01133V00000X
FLND-12637133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered