Provider Demographics
NPI:1407529357
Name:LOOLOIAN, SHEA NOELLE (RD LD)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:NOELLE
Last Name:LOOLOIAN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 OLD PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2049
Mailing Address - Country:US
Mailing Address - Phone:913-579-8635
Mailing Address - Fax:
Practice Address - Street 1:355 N 21ST ST STE 208
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-3707
Practice Address - Country:US
Practice Address - Phone:717-836-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004886133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN004886OtherUNKNOWN