Provider Demographics
NPI:1053435438
Name:SHRODES, JENNIFER C (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:SHRODES
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 DENNISON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3262
Mailing Address - Country:US
Mailing Address - Phone:614-884-4400
Mailing Address - Fax:614-884-4484
Practice Address - Street 1:1100 DENNISON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3262
Practice Address - Country:US
Practice Address - Phone:614-884-4400
Practice Address - Fax:614-884-4484
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD5288133V00000X
OH920297133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSHMT03261Medicare UPIN