Provider Demographics
NPI:1023578499
Name:BARR, SHALYNNE LYNNATT (CNC)
Entity Type:Individual
Prefix:
First Name:SHALYNNE
Middle Name:LYNNATT
Last Name:BARR
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21751 W 11 MILE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3780
Mailing Address - Country:US
Mailing Address - Phone:248-509-0096
Mailing Address - Fax:
Practice Address - Street 1:21751 W 11 MILE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3780
Practice Address - Country:US
Practice Address - Phone:248-509-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NUT17028526133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty