Provider Demographics
NPI:1568812469
Name:SHAFFER, LINDSEY (RD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:SHAFFER
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 1:10450 ALGONQUIN RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7064
Mailing Address - Country:US
Mailing Address - Phone:815-334-5566
Mailing Address - Fax:847-802-7259
Practice Address - Street 1:10450 ALGONQUIN RD STE 100A
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7064
Practice Address - Country:US
Practice Address - Phone:815-334-5566
Practice Address - Fax:847-802-7259
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006847133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered