Provider Demographics
NPI:1497432447
Name:MORTON, SHAKEIRA T (RDN)
Entity Type:Individual
Prefix:
First Name:SHAKEIRA
Middle Name:T
Last Name:MORTON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 HAWES AVE APT 323
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-4678
Mailing Address - Country:US
Mailing Address - Phone:260-615-0528
Mailing Address - Fax:
Practice Address - Street 1:2223 HAWES AVE APT 323
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-4678
Practice Address - Country:US
Practice Address - Phone:260-615-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX916719133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered