Provider Demographics
NPI:1174184956
Name:SHAZLY, LINDSAY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:SHAZLY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-3902
Mailing Address - Country:US
Mailing Address - Phone:803-777-0742
Mailing Address - Fax:
Practice Address - Street 1:1401 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-3902
Practice Address - Country:US
Practice Address - Phone:803-777-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1346133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered