MEDICARE: MS. SHELLEY LYNNE CARLEY RD

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	498198

General Provider Information

NPI Number	:	1639228372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY LYNNE CARLEY RD

Provider Business Mailing Address
First Line	:	9048 SUGAR ESTATE
Second Line	:	NUTRITION SERVICES
City	:	ST. THOMAS
State	:	VI
Zip	:	00802-4001
Country	:	US
Telephone Number	:	340-776-8311
Fax Number	:	340-714-6312

Provider Business Practice Location Address
First Line	:	9048 SUGAR ESTATE
Second Line	:
City	:	ST. THOMAS
State	:	VI
Zip	:	00802-4001
Country	:	US
Telephone Number	:	340-776-8311
Fax Number	:	340-714-6312

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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