Kaitlyn Marie Shannon, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86085245 Issued in AZ

Practice address

20325 North 51St Avenue
Building 9, Suite 166
Glendale, AZ 85308

Phone

(602) 341-5248

Fax

(602) 702-5219

NPI assigned

Feb 17, 2020

Last updated

Mar 19, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1033742291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20325 NORTH 51ST AVENUE",
            "address_2": "BUILDING 9, SUITE 166",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "602-341-5248",
            "fax_number": "602-702-5219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20325 NORTH 51ST AVENUE",
            "address_2": "BUILDING 9, SUITE 166",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "602-341-5248",
            "fax_number": "602-702-5219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7362 W Thunderbird Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853815028",
            "country_code": "US",
            "telephone_number": "602-341-5248",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5620 W Thunderbird Rd Ste G2",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853064652",
            "country_code": "US",
            "telephone_number": "602-341-5248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "KAITLYN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AZ",
            "license": "86085245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Registered Dietitian in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.