Individual
SHANE MIKESKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-7220
(505) 846-3200
Mailing address
3832 LA CHARLES DR NE, ALBUQUERQUE, NM 87111-4116
(317) 650-7234
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86174678
—
Other
Enumeration date
06/23/2022
Last updated
02/06/2026
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