MEDICARE: SHELLEY CHANCEY R.D., L.D.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND 8159	FL

General Provider Information

NPI Number	:	1609315076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY CHANCEY R.D., L.D.N.

Provider Business Mailing Address
First Line	:	2380 3RD ST S STE 1
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-8039
Country	:	US
Telephone Number	:	904-270-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	2380 3RD ST S STE 1
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-8039
Country	:	US
Telephone Number	:	904-270-1234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2017
Last Update Date	:	02/21/2017

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