Provider Demographics
NPI:1033776026
Name:MEADOWS, SHANNON MARIE (RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARIE
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MAITLAND ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3930
Mailing Address - Country:US
Mailing Address - Phone:410-914-7610
Mailing Address - Fax:443-773-5504
Practice Address - Street 1:221 MAITLAND ST STE 204
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3930
Practice Address - Country:US
Practice Address - Phone:410-914-7610
Practice Address - Fax:443-773-5504
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3078133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered