Shannon Doran Fenster, CN

Primary specialty

NutritionistTaxonomy code 133N00000X

License

NU00001751 Issued in WA

Practice address

11801 NE 158TH St
Bothell, WA 98011-4138

Phone

(206) 491-3008

NPI assigned

Jun 15, 2007

Sex

Female

Sole proprietor

Yes

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": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1992900518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11801 NE 158TH ST",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980114138",
            "telephone_number": "206-491-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11801 NE 158TH ST",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980114138",
            "telephone_number": "206-491-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENSTER",
        "first_name": "SHANNON",
        "middle_name": "DORAN",
        "name_prefix": "Mrs.",
        "credential": "CN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-15",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "WA",
            "license": "NU00001751",
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "WA",
            "license": "NU00001751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nutritionist in Bothell, WA
• Providers in Bothell, WA by specialty
• Nutritionist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.