Healthcare Provider Details

I. General information

NPI: 1992811988
Provider Name (Legal Business Name): VADEL YVETTE SHIVERS LDN, RDN, PHD, CSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 ESSEN LN
BATON ROUGE LA
70809-3738
US

IV. Provider business mailing address

5215 ESSEN LN STE 200
BATON ROUGE LA
70809-3543
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-0847
  • Fax:
Mailing address:
  • Phone: 225-767-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number1610
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: