Provider Demographics
NPI:1497157499
Name:BROGNI, SHELLY (RD, LD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:BROGNI
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 1:1948 COVINGTON LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2696
Mailing Address - Country:US
Mailing Address - Phone:651-404-1543
Mailing Address - Fax:
Practice Address - Street 1:1175 NININGER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1056
Practice Address - Country:US
Practice Address - Phone:651-404-1543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2471133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered