Provider Demographics
NPI:1215606306
Name:GOOD, SHEILA DIANNE (RDN)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:DIANNE
Last Name:GOOD
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16360 JAVARI CT
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6831
Mailing Address - Country:US
Mailing Address - Phone:952-457-4170
Mailing Address - Fax:
Practice Address - Street 1:1450 ENERGY PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5219
Practice Address - Country:US
Practice Address - Phone:651-361-7291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1522133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered