Shannon Mooney Wickman, RD, LDN, CSOWM

Primary specialty

Obesity and Weight Management Nutrition Registered DietitianTaxonomy code 133VN1201X

License

DI1082 Issued in ME

Practice address

72 Main St
Kennebunk, ME 04043-7021

Phone

(207) 467-8825

Fax

(207) 467-8811

NPI assigned

Oct 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Shannon Margaret Mooney Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mainehealth

  • Community/Retail Pharmacy
  • Portland, ME
  • NPI 1013868181
  NPD
• Mainehealth

  • Ophthalmology Physician
  • Portland, ME
  • NPI 1730378894
  NPD
• Mainehealth

  • Psychiatric Hospital
  • Westbrook, ME
  • NPI 1790265502
  NPD
• Mainehealth

  • Clinic/Center
  • Portland, ME
  • NPI 1487346722
  NPD (past)

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1356423024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 MAIN ST",
            "city": "KENNEBUNK",
            "state": "ME",
            "postal_code": "040437021",
            "telephone_number": "207-467-8825",
            "fax_number": "207-467-8811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 MAIN ST",
            "city": "KENNEBUNK",
            "state": "ME",
            "postal_code": "040437021",
            "telephone_number": "207-467-8825",
            "fax_number": "207-467-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKMAN",
        "first_name": "SHANNON",
        "middle_name": "MOONEY",
        "name_prefix": "Mrs.",
        "credential": "RD, LDN, CSOWM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-20",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "2439",
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": "ME",
            "license": "DI1082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "MOONEY",
            "middle_name": "MARGARET",
            "prefix": "MS.",
            "credential": "RD, LDN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rachel Wells, LCPC-C, MT-BC
• Anne Caruthers Wepfer, OTD
• Katherine Stevens Westmoreland, LCPC LMFT MS MED
• Dana J White, MPT
• Molly D Whitehead
• Colby Wilson, DC
• Sara Wilson
• Lindsey Boisclair Withrow, LCMHC, LCPC
• Joseph F. Wojcik, PH.D.
• Miriam Wolfenstein, PH.D.

• Obesity and Weight Management Nutrition Registered Dietitian in Kennebunk, ME
• Providers in Kennebunk, ME by specialty
• Obesity and Weight Management Nutrition Registered Dietitian in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.