Provider Demographics
NPI:1558168369
Name:CAHO, SHELBY (RD, LDN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:CAHO
Suffix:
Gender:
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4732
Mailing Address - Country:US
Mailing Address - Phone:309-634-5044
Mailing Address - Fax:
Practice Address - Street 1:4500 W FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-4732
Practice Address - Country:US
Practice Address - Phone:309-634-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86302179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered