Healthcare Provider Details

I. General information

NPI: 1386186799
Provider Name (Legal Business Name): SHELLEY SCHWARTZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N WACKER DR STE 1250
CHICAGO IL
60606-1911
US

IV. Provider business mailing address

15316 JILLIAN CT
ORLAND PARK IL
60467-4607
US

V. Phone/Fax

Practice location:
  • Phone: 800-774-5962
  • Fax:
Mailing address:
  • Phone: 708-670-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.005251
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: