Provider Demographics
NPI:1982150314
Name:LOVE, SHELBY (RDN, LD, CDCES)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:RDN, LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 14TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6023
Mailing Address - Country:US
Mailing Address - Phone:813-803-5996
Mailing Address - Fax:
Practice Address - Street 1:5040 14TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6023
Practice Address - Country:US
Practice Address - Phone:813-803-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9386133V00000X
GALD004731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered