Healthcare Provider Details

I. General information

NPI: 1821344979
Provider Name (Legal Business Name): SHALANE MARIE PITTS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604B COLISEUM BLVD
ALEXANDRIA LA
71303-3709
US

IV. Provider business mailing address

1243 HORSESHOE DR
COTTONPORT LA
71327-3607
US

V. Phone/Fax

Practice location:
  • Phone: 318-487-5260
  • Fax: 318-487-5338
Mailing address:
  • Phone: 318-359-0595
  • Fax: 318-487-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number581
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: