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General NPI Number Information
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NPI Number | 1750291951
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Entity Type | Individual
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Provider Name | KELLEY TRACEY SHANAHAN RDN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 28 CLEMENT ST APT 3
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City | WORCESTER
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State | MA
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Zip | 01603-2403
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Country | US
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Telephone | 508-838-7386
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Fax |
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Provider Business Mailing Address
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Address Line | 3724 JEFFERSON ST STE 104
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City | AUSTIN
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State | TX
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Zip | 78731-6204
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Country | US
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Telephone | 512-693-7045
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Fax | 512-399-9039
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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 | 86404460
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License Number State | MA
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