Provider Demographics
NPI:1962969931
Name:BAGSHAW, SHAYNA J (RD)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:J
Last Name:BAGSHAW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 5TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3947
Mailing Address - Country:US
Mailing Address - Phone:520-870-7880
Mailing Address - Fax:
Practice Address - Street 1:5 BON AIR RD STE 117
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1138
Practice Address - Country:US
Practice Address - Phone:415-448-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86063915133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86063915OtherCOMMISSION ON DIETETIC REGISTRATION