Provider Demographics
NPI:1407041353
Name:SHIEH, CONNIE S (RD)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:S
Last Name:SHIEH
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 1:12200 BELLFLOWER BLVD
Mailing Address - Street 2:HEALTH EDUCATION DEPARTMENT
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2804
Mailing Address - Country:US
Mailing Address - Phone:562-622-4162
Mailing Address - Fax:562-622-4166
Practice Address - Street 1:12200 BELLFLOWER BLVD
Practice Address - Street 2:HEALTH EDUCATION DEPARTMENT
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2804
Practice Address - Country:US
Practice Address - Phone:562-622-4162
Practice Address - Fax:562-622-4166
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360086133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered