Provider Demographics
NPI:1265443592
Name:MARIE REDMOND, SHELLY (MS, LDN, RD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:MARIE REDMOND
Suffix:
Gender:F
Credentials:MS, LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6925 QUERBES DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2417
Mailing Address - Country:US
Mailing Address - Phone:318-426-0987
Mailing Address - Fax:
Practice Address - Street 1:6925 QUERBES DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2417
Practice Address - Country:US
Practice Address - Phone:318-426-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered