Provider Demographics
NPI:1164091724
Name:WRIGHT, SHELBY ANN
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:ANN
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7518 BRIARGROVE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8389
Mailing Address - Country:US
Mailing Address - Phone:623-313-4742
Mailing Address - Fax:
Practice Address - Street 1:7518 BRIARGROVE LN
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8389
Practice Address - Country:US
Practice Address - Phone:623-313-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5296133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered