Individual
LISA RAYNELLE SHELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, CDE, BC-ADM
Contact information
Practice address
2460 CURTIS ELLIS DR, ROCKY MOUNT, NC 27804
(806) 212-0577
(806) 212-0563
Mailing address
PO BOX 847556, DALLAS, TX 75284-7556
(806) 212-0577
(806) 212-0563
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
DT80908
TX
133V00000X
Registered Dietitian
Primary
L005339
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200913419
AMERICAN ASSOCIATION OF DIABETIC EDUCATORS
—
01
—
20120483
NCBDE
—
01
—
942472
AMERICAN DIETETIC ASSOCIATION
TX
01
—
DT80908
TEXAS STATE BOARD OF EXAMINERS OF DIETITIANS
TX
Enumeration date
09/06/2008
Last updated
08/20/2018
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