Provider Demographics
NPI:1528328259
Name:SHELLEY, SHERRIE LEEANNE (NTP)
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:LEEANNE
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22019 HIGHWAY 99
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8023
Mailing Address - Country:US
Mailing Address - Phone:425-774-2411
Mailing Address - Fax:
Practice Address - Street 1:22019 HIGHWAY 99
Practice Address - Street 2:SUITE A
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8023
Practice Address - Country:US
Practice Address - Phone:425-774-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist