Provider Demographics
NPI:1609283191
Name:FRITCH, SHELLEY FEHRENBACH
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:FEHRENBACH
Last Name:FRITCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:CHRISTINE
Other - Last Name:FEHRENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD
Mailing Address - Street 1:PO BOX 269025
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9025
Mailing Address - Country:US
Mailing Address - Phone:405-271-1500
Mailing Address - Fax:405-271-4995
Practice Address - Street 1:1200 CHILDRENS AVE # 4D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-8001
Practice Address - Fax:405-271-4995
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1758133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered