Provider Demographics
NPI:1144096546
Name:SHANNON SCOTT NUTRITION LLC
Entity type:Organization
Organization Name:SHANNON SCOTT NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:203-530-0127
Mailing Address - Street 1:72 SCONSET LN
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1899
Mailing Address - Country:US
Mailing Address - Phone:203-530-0127
Mailing Address - Fax:
Practice Address - Street 1:72 SCONSET LN
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1899
Practice Address - Country:US
Practice Address - Phone:203-530-0127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center