Molly Shattuck, RD

Primary specialty

Renal Nutrition Registered DietitianTaxonomy code 133VN1005X

License

164005153 Issued in IL

Practice address

400 John Deere Rd
Moline, IL 61265-6898

Phone

(309) 762-0200

NPI assigned

Nov 4, 2011

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320364800000",
    "number": "1912284977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2514 3RD ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612655105",
            "telephone_number": "309-781-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 JOHN DEERE RD",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656898",
            "telephone_number": "309-762-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "MOLLY",
        "name_prefix": "Mrs.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-04",
        "last_updated": "2011-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IA",
            "license": "001928",
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "IL",
            "license": "164005153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip J Sepanski, LCPC
• David Victor Shaffer, D.C.
• Leslie Anne Shaffer, PHARMD
• Dipak S. Shah, M.D.
• Zacariah Shannon, D.C.
• Jennifer Shaw, ARNP
• Maille Sheerin
• Elizabeth R Shelly, PT
• Mark Jung-Ching Shen, M.D.
• Michelle R. Shepherd, PMHNP-BC

• Renal Nutrition Registered Dietitian in Moline, IL
• Providers in Moline, IL by specialty
• Renal Nutrition Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; 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.