Provider Demographics
NPI:1215627682
Name:COBB, SHELLY KAY (MS, BCHN)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:KAY
Last Name:COBB
Suffix:
Gender:F
Credentials:MS, BCHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28481 RANCHO CALIFORNIA RD STE 202
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3619
Mailing Address - Country:US
Mailing Address - Phone:951-404-8805
Mailing Address - Fax:951-257-7230
Practice Address - Street 1:28481 RANCHO CALIFORNIA RD STE 202
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3619
Practice Address - Country:US
Practice Address - Phone:951-404-8805
Practice Address - Fax:951-257-7230
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
CA133NN1002X
OR171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach