Provider Demographics
NPI:1407928948
Name:CUMMINS, SHELLY LEA (RD)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:LEA
Last Name:CUMMINS
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 1:10012 E. C.R. 500 S.
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:IN
Mailing Address - Zip Code:47383
Mailing Address - Country:US
Mailing Address - Phone:765-747-8168
Mailing Address - Fax:
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-747-3345
Practice Address - Fax:765-747-3269
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2965000DMedicare ID - Type UnspecifiedUPLAND HEALTH & DIAGNOSTI
IN940810PMedicare Oscar/Certification