SHANNON MICHELLE SUNDBERG (NPI# 1154670503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154670503 |
| Entity Type | Individual |
| Full Name | SHANNON MICHELLE SUNDBERG |
| Credential | MS, RD, CD |
| Practice Address |
100 Mario Capecchi Dr Salt Lake City UT 84113-1103 |
| Practice Telephone | 8012771207 |
| Mailing Telephone | 8012771207 |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2012-08-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133VN1004X |
Dietitian, Registered Specialization: Nutrition, Pediatric |
3781234901 | UT | Dietary & Nutritional Service Providers |
| Street Address |
100 MARIO CAPECCHI DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84113-1103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033111810 | Andrew Gerald Smith | Legal Medicine | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2005-08-11 |
| 1235535485 | Ihc Health Services Inc | Clinic/Center | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2014-11-17 |
| 1508262833 | Aimee Brierley | Occupational Therapist | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2014-11-13 |
| 1801290986 | Jeffery Zobell | Pharmacist | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2014-10-17 |
| 1336542778 | Bevan Jensen | Pharmacist | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2014-09-30 |
| 1699183152 | Kristina Rogers | Dentist | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2014-07-29 |
| 1548677297 | Stephanie Eva Wisniewski | Speech-Language Pathologist | 100 Mario Capecchi Dr, Primary Children's Rehab, Salt Lake City, UT 84113-1103 | 2014-07-15 |
| 1184044877 | Adam Wesley Dell | Pediatrics | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2014-04-21 |
| 1225456718 | Bhanu Muniyappa | Pediatrics | 100 Mario Capecchi Dr, Pediatrics Residency Program, Salt Lake City, UT 84113-1103 | 2014-04-01 |
| 1265850952 | Kristina Gulliver | Pediatrics | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2014-03-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386111060 | Melissa Marie Dixon | Psychologist | Primary Children's Hospital Outpatient Services, 81 South Mario Capecchi Drive, Salt Lake City, UT 84113 | 2018-10-31 |
| 1366965618 | Ashley Stuart | Psychologist | 44 North Mario Capecchi Drive, Salt Lake City, UT 84113 | 2017-07-19 |
| 1487945135 | Justin C Wheeler | Pediatrics | 81 N Mario Capecchi Dr Fl 4, Salt Lake City, UT 84113 | 2011-04-29 |
| 1154612117 | Dana Boucek | Pediatrics | 100 North Mario Capecchi Dr., Primary Children's, Salt Lake City, UT 84113 | 2011-04-26 |
| 1285959502 | Anna Katherine Eyre Ermarth | Pediatrics | 81 Mario Capecchi, Salt Lake City, UT 84113 | 2010-03-30 |
| 1457682072 | Elizabeth K Cho | Nurse Practitioner | 100 North Mario Cappechi Dr., Salt Lake City, UT 84113 | 2010-01-21 |
| 1528290848 | Nancy Crandell Brown | Nurse Practitioner | 100 North Mario Cappechi Drive, Salt Lake City, UT 84113 | 2009-08-20 |
| 1679708481 | Primary Children's Medical Center | General Acute Care Hospital | 100 No. Mario Capecchi Drive, Salt Lake, UT 84113 | 2009-05-22 |
| 1467697235 | Tara Hook | Physical Therapist | 100 North Mario Capecchi Dr, Salt Lake City, UT 84113 | 2008-12-09 |
| 1144474768 | Jennifer K Workman | Pediatrics | 100 N Mario Capecchi Drive, Pediatric Crtical Care, Primary Children's Hospital, Salt Lake City, UT 84113 | 2008-11-10 |
| Find all providers in zip 84113 | ||||
| Taxonomy Code | 133VN1004X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Pediatric |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174996151 | Susan Reese | Dietitian, Registered | 2147 E Pinnacle Terrace Way, Apt 103, Salt Lake City, UT 84121-5062 | 2015-11-12 |
| 1063021699 | Sara Stevenson | Dietitian, Registered | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-07-29 |
| 1306475124 | Nicole Williams | Dietitian, Registered | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-04-03 |
| 1487165908 | Jessica Brothers Clayton | Dietitian, Registered | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2017-10-24 |
| 1649717562 | Madeline Gochnour | Dietitian, Registered | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2017-01-30 |
| 1528421435 | Moira Flannery Kryger | Dietitian, Registered | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-03-30 |
| 1447610936 | Cynthia Panish | Dietitian, Registered | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-02-26 |
| 1801146279 | Kristen Strong | Dietitian, Registered | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2012-09-13 |
| 1083964514 | Janet Gardner Bowman | Dietitian, Registered | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2012-09-12 |
| 1164771572 | Catherine M. Mcdonald | Dietitian, Registered | 100 Mario Capecchi Dr, Dietitians' Office, 2nd Floor, Salt Lake City, UT 84113-1103 | 2012-08-30 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84113 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.