MRS. SHANNON MOONEY WICKMAN RD, LDN, CSOWM
NPI 1356423024
Dietitian, Registered - Nutrition, Obesity and Weight Management in Kennebunk, ME

Q: What is Shannon Wickman's NPI number?

The NPI number for Shannon Wickman is 1356423024. It was assigned to this individual provider in the NPPES registry on October 20, 2006. The provider is also known as Ms. Shannon Margaret Mooney Rd, Ldn.

Q: What is Shannon Wickman's specialty?

The primary specialty registered for this NPI is Dietitian, Registered, specializing in Nutrition, Obesity and Weight Management, with taxonomy code 133VN1201X.

Q: When was this NPI record last updated?

The NPPES record for Shannon Wickman was last updated on July 24, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 20, 2006

72 MAIN ST, KENNEBUNK, ME 04043(207) 467-8825(207) 467-8811 Get Directions Write a Review

NPPES record last updated: July 24, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Mrs. Shannon Mooney Wickman Rd, Ldn, Csowm NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. SHANNON MOONEY WICKMAN RD, LDN, CSOWM (NPI 1356423024) is an individual nutrition, obesity and weight management provider in Kennebunk, Maine, licensed in Maine (DI1082) and active in the NPI registry since October 2006.

NPPES Registry Identity

NPI1356423024

Entity TypeIndividualFemale

Primary Taxonomy133VN1201X

Provider Legal NameMRS. SHANNON MOONEY WICKMANCredential: RD, LDN, CSOWM

Location Address72 MAIN STKennebunk, ME 04043-7021

Mailing Address72 Main StKennebunk, ME 04043-7021 · (207) 467-8825 · Fax (207) 467-8811

Phone(207) 467-8825

Fax(207) 467-8811

Sole ProprietorNo

Enumeration DateOctober 20, 2006

Last NPPES UpdateJuly 24, 2023

NPPES CertifiedJuly 24, 2023

✔ NPI 1356423024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDietitian, Registered · Nutrition, Obesity and Weight ManagementDietary & Nutritional Service Providers

Taxonomy Code133VN1201X

License✔ Licensed in ME · DI1082

Definition

An individual who is a Board Certified Specialist for Obesity and Weight Management and educates, supports, and advocates for patients and clients to understand and manage their weight and associated risks through the use of nutritional, behavioral health, medical, surgical, pharmacotherapeutic, and exercise and physical activity interventions.

Also ListedDietitian, RegisteredTaxonomy 133V00000X · License 2439 (MA)

72 MAIN ST, Kennebunk, ME 04043

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Other Names 1

Former Name (1)Ms. Shannon Margaret Mooney Rd, Ldn

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ARIANNA GENEVIEVE BOGUCKI RD

Dietitian, Registered (Nutrition, Obesity and Weight Management)