Healthcare Provider Details

I. General information

NPI: 1639228372
Provider Name (Legal Business Name): SHELLEY LYNNE CARLEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9048 SUGAR ESTATE
ST. THOMAS VI
00802-4001
US

IV. Provider business mailing address

9048 SUGAR ESTATE NUTRITION SERVICES
ST. THOMAS VI
00802-4001
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-8311
  • Fax: 340-714-6312
Mailing address:
  • Phone: 340-776-8311
  • Fax: 340-714-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number498198
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: