Provider Demographics
NPI:1619428976
Name:MALONE, SHELLY (MPH, RD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:828 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6602
Mailing Address - Country:US
Mailing Address - Phone:310-383-1329
Mailing Address - Fax:
Practice Address - Street 1:828 1ST ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6602
Practice Address - Country:US
Practice Address - Phone:310-383-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA913818133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered