Provider Demographics
NPI:1285745232
Name:WOLD, SHELLEY (RD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:WOLD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:ANN
Other - Last Name:WOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:600 ORONDO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-6000
Mailing Address - Fax:509-682-4583
Practice Address - Street 1:600 ORONDO AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2800
Practice Address - Country:US
Practice Address - Phone:509-682-6000
Practice Address - Fax:509-682-4583
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001236133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8272072OtherDSHS