Provider Demographics
NPI:1295026870
Name:SHEPP, ALEXANDRA JOYCE (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:JOYCE
Last Name:SHEPP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:JOYCE
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1045 HIAWATHA AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8142
Mailing Address - Country:US
Mailing Address - Phone:507-251-9197
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered