Provider Demographics
NPI:1407315153
Name:SALES, SHAWN A (RD)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:A
Last Name:SALES
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:A
Other - Last Name:SALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1607 BONNYCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1012
Mailing Address - Country:US
Mailing Address - Phone:502-235-8097
Mailing Address - Fax:
Practice Address - Street 1:1607 BONNYCASTLE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1012
Practice Address - Country:US
Practice Address - Phone:502-235-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY976300133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered