Provider Demographics
NPI:1376817627
Name:LANDIS, SHEILA (NTP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:LANDIS
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 SW TANAGER TER
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8338
Mailing Address - Country:US
Mailing Address - Phone:503-799-3450
Mailing Address - Fax:971-228-0311
Practice Address - Street 1:11105 SW TANAGER TER
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8338
Practice Address - Country:US
Practice Address - Phone:503-799-3450
Practice Address - Fax:971-228-0311
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR001165133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist