Provider Demographics
NPI:1699720177
Name:SHILLING, BRENDA CHRISTINE (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:CHRISTINE
Last Name:SHILLING
Suffix:
Gender:F
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 1:1000 LION ROAD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:CHERRY TREE
Mailing Address - State:PA
Mailing Address - Zip Code:15724
Mailing Address - Country:US
Mailing Address - Phone:814-743-6565
Mailing Address - Fax:724-357-7414
Practice Address - Street 1:1000 LION ROAD
Practice Address - Street 2:DIETICIAN
Practice Address - City:CHERRY TREE
Practice Address - State:PA
Practice Address - Zip Code:15724
Practice Address - Country:US
Practice Address - Phone:814-743-6565
Practice Address - Fax:724-357-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003463133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered