Provider Demographics
NPI:1386186799
Name:SCHWARTZ, SHELLEY (RD)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15316 JILLIAN CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4607
Mailing Address - Country:US
Mailing Address - Phone:708-670-0084
Mailing Address - Fax:
Practice Address - Street 1:123 N WACKER DR STE 1250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1911
Practice Address - Country:US
Practice Address - Phone:800-774-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered