Provider Demographics
NPI:1699553198
Name:MILLER, SHELBY (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9716 W 51ST PL
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-1600
Mailing Address - Country:US
Mailing Address - Phone:972-757-1175
Mailing Address - Fax:
Practice Address - Street 1:9716 W 51ST PL
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66203-1600
Practice Address - Country:US
Practice Address - Phone:972-757-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered