Provider Demographics
NPI:1033503875
Name:SCHULTZ, SHAUNA (RD, CD)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25618 LAKE WILDERNESS COUNTRY CLUB DR SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6010
Mailing Address - Country:US
Mailing Address - Phone:530-906-4803
Mailing Address - Fax:
Practice Address - Street 1:25618 LAKE WILDERNESS COUNTRY CLUB DR SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6010
Practice Address - Country:US
Practice Address - Phone:530-906-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60454185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered