Provider Demographics
NPI:1144054016
Name:KIRCHOFF, SHEYENNE MIKAELA
Entity type:Individual
Prefix:
First Name:SHEYENNE
Middle Name:MIKAELA
Last Name:KIRCHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STORKE RD UNIT 80553
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93118-7065
Mailing Address - Country:US
Mailing Address - Phone:805-252-8300
Mailing Address - Fax:
Practice Address - Street 1:400 STORKE RD
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93118-7001
Practice Address - Country:US
Practice Address - Phone:805-252-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-31
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86360369133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered