Provider Demographics
NPI:1174553325
Name:DAKIN, SHIRLEY (RD,CDE)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:DAKIN
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ROSE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:MC HENRY
Mailing Address - State:MS
Mailing Address - Zip Code:39561-6186
Mailing Address - Country:US
Mailing Address - Phone:228-523-5154
Mailing Address - Fax:
Practice Address - Street 1:280 DAVID L GOLDFEIN ST BLDG 23
Practice Address - Street 2:
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS851068133V00000X
NM851068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered