Provider Demographics
NPI:1174988042
Name:LEININGER, SHANNON D (MED, RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:D
Last Name:LEININGER
Suffix:
Gender:F
Credentials:MED, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 POSSIBILITIES ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5332
Mailing Address - Country:US
Mailing Address - Phone:702-845-7175
Mailing Address - Fax:
Practice Address - Street 1:500 N RAINBOW BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1061
Practice Address - Country:US
Practice Address - Phone:702-508-0630
Practice Address - Fax:702-508-0637
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-20
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32846DI-1133V00000X
NV32846-DI-3133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered