Provider Demographics
NPI:1407495740
Name:LOPEZ, SHELLY (RD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2789 WESTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7517
Mailing Address - Country:US
Mailing Address - Phone:720-937-1596
Mailing Address - Fax:
Practice Address - Street 1:1750 PIERCE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-1434
Practice Address - Country:US
Practice Address - Phone:303-238-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered