Provider Demographics
NPI:1568790541
Name:LEWIS, SHELLEY (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:ALSPAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:6301 IVY LN
Mailing Address - Street 2:STE 410
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-6357
Mailing Address - Country:US
Mailing Address - Phone:301-474-2499
Mailing Address - Fax:301-474-5943
Practice Address - Street 1:7219 D HANOVER PKWY SUITE D
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-474-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered