Provider Demographics
NPI:1568253599
Name:SHORTER, TIANNA
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:
Last Name:SHORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIANA
Other - Middle Name:
Other - Last Name:SHORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:316 S OAKLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2918
Mailing Address - Country:US
Mailing Address - Phone:773-517-3024
Mailing Address - Fax:773-517-3024
Practice Address - Street 1:960 W CULLERTON ST APT 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3480
Practice Address - Country:US
Practice Address - Phone:312-799-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty