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General NPI Number Information
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NPI Number | 1093139677
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Entity Type | Individual
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Provider Name | SHELLY EDENS R.D., C.S.O., L.D.N.
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Gender | Female
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 60 MEMORIAL MEDICAL PKWY FOOD AND NUTRITION DEPARTMENT
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City | PALM COAST
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State | FL
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Zip | 32164-5980
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Country | US
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Telephone | 386-586-4320
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Fax |
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Provider Business Mailing Address
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Address Line | 8539 GATE PKWY W UNIT 1435
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND 5449
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License Number State | FL
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