| Doctor Name: | MALLORY SHAN |
| NPI Number: | 1821426826 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LDN, RD |
| License Number: | 1076733 |
| Business Practice Address: | 1290 Tremont St Roxbury, MA - 021203432 |
| Business Phone Number: | 6174271000 |
| Business Fax Number: | |
| Mailing Address: | 1290 Tremont St, ROXBURY |
| State: | MA |
| Postal Code: | 021203432 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2013 |
| NPI Last Update Date: | 10/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 1076733 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |