MEDICARE: SHELLY LOPEZ RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1407495740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY LOPEZ RD

Provider Business Mailing Address
First Line	:	2789 WESTGATE AVE
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7517
Country	:	US
Telephone Number	:	720-937-1596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 PIERCE ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80214-1434
Country	:	US
Telephone Number	:	303-238-6111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	01/03/2020

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