Provider Demographics
NPI:1982401311
Name:TSAKALAKIS, SHANNON RILEY (RD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RILEY
Last Name:TSAKALAKIS
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11572 TERRAWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3028
Mailing Address - Country:US
Mailing Address - Phone:303-549-2994
Mailing Address - Fax:
Practice Address - Street 1:11572 TERRAWOOD CT
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3028
Practice Address - Country:US
Practice Address - Phone:303-549-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
855484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered