Provider Demographics
NPI:1962625012
Name:TOKARSKI, SHANNON MARIE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:TOKARSKI
Suffix:
Gender:
Credentials:MS, RD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:BLOODWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31214 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1082
Mailing Address - Country:US
Mailing Address - Phone:586-823-4577
Mailing Address - Fax:
Practice Address - Street 1:31214 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1082
Practice Address - Country:US
Practice Address - Phone:586-823-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL925835133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered