Healthcare Provider Details

I. General information

NPI: 1487980546
Provider Name (Legal Business Name): SHAUN RIEBL PHD, RDN, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MASON FARM RD CB# 7705
CHAPEL HILL NC
27599-6134
US

IV. Provider business mailing address

1331 TRAIL VIEW LN
DURHAM NC
27713-6046
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-3876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND5526
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberL004645
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: