Provider Demographics
NPI:1568711455
Name:IRBY, SHELISE ANNE (RD)
Entity Type:Individual
Prefix:MS
First Name:SHELISE
Middle Name:ANNE
Last Name:IRBY
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 1:5898 CLARK RD.
Mailing Address - Street 2:STE. 1
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4800
Mailing Address - Country:US
Mailing Address - Phone:530-876-8484
Mailing Address - Fax:530-876-8444
Practice Address - Street 1:5898 CLARK RD.
Practice Address - Street 2:STE. 1
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4800
Practice Address - Country:US
Practice Address - Phone:530-876-8484
Practice Address - Fax:530-876-8444
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1057514133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered