Provider Demographics
NPI:1699986679
Name:FILLIPP, SHELLEY JEAN (RD)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:JEAN
Last Name:FILLIPP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 KNOXVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5415
Mailing Address - Country:US
Mailing Address - Phone:806-798-8552
Mailing Address - Fax:
Practice Address - Street 1:5022 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2700
Practice Address - Country:US
Practice Address - Phone:806-725-5460
Practice Address - Fax:806-765-0760
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01443133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered