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General NPI Number Information
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NPI Number | 1871979328
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Entity Type | Individual
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Provider Name | SHELLEY LANELLE BLAKENEY RDN, CSP, LD
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Gender | Female
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 120 THOMAS CT
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City | TUSCOLA
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State | TX
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Zip | 79562-1181
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Country | US
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Telephone | 214-763-8415
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Fax |
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Provider Business Mailing Address
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Address Line | 120 THOMAS CT
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City | TUSCOLA
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State | TX
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Zip | 79562-1181
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Country | US
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Telephone | 214-763-8415
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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 | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | DT81052
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT81052
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License Number State | TX
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