Provider Demographics
NPI:1972330488
Name:STAMBAUGH, SHAMRON (NE)
Entity type:Individual
Prefix:
First Name:SHAMRON
Middle Name:
Last Name:STAMBAUGH
Suffix:
Gender:F
Credentials:NE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4621
Mailing Address - Country:US
Mailing Address - Phone:423-586-6431
Mailing Address - Fax:423-586-6324
Practice Address - Street 1:331 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4621
Practice Address - Country:US
Practice Address - Phone:423-586-6431
Practice Address - Fax:423-586-6324
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education