Healthcare Provider Details

I. General information

NPI: 1669286134
Provider Name (Legal Business Name): SHELBY OSBORNE RDN, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 E 12300 S
DRAPER UT
84020-9587
US

IV. Provider business mailing address

1080 E 500 S
PLEASANT GROVE UT
84062-3102
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-8050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86174714
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86174714
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: