Provider Demographics
NPI:1023989191
Name:SHANNON, CAROLINE (MS, RDN, CDN)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1404
Mailing Address - Country:US
Mailing Address - Phone:518-210-4457
Mailing Address - Fax:
Practice Address - Street 1:8 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1404
Practice Address - Country:US
Practice Address - Phone:518-210-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011190133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered