Provider Demographics
NPI:1972637395
Name:DONNELLY, SHEILA (RD,LDN)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:DONNELLY
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 1:655 BARDWELL RD
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-2208
Mailing Address - Country:US
Mailing Address - Phone:570-836-7319
Mailing Address - Fax:
Practice Address - Street 1:655 BARDWELL RD
Practice Address - Street 2:
Practice Address - City:FACTORYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18419-2208
Practice Address - Country:US
Practice Address - Phone:570-836-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003661133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered