Active NPI
Shannon Graham, MS, RDN, LDN
- Registered Dietitian
- Wilkes Barre, PA
National Provider Identifier
1609579663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DN007835
- Practice address
- 1000 E Mountain Dr
Wilkes Barre, PA 18711-0027 - Phone
- (570) 808-7803
- Fax
- (570) 808-3230
- NPI assigned
- Mar 27, 2023
- Last updated
- Sep 27, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DN007835 | PA | Primary |
Addresses
Primary practice location
1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Mailing address
100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN007835 | PA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695772800000",
"number": "1609579663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N ACADEMY AVE",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178224903",
"telephone_number": "570-271-6144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E MOUNTAIN DR",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187110027",
"telephone_number": "570-808-7803",
"fax_number": "570-808-3230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "SHANNON",
"credential": "MS, RDN, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-27",
"last_updated": "2023-09-27",
"certification_date": "2023-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "DN007835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.