Provider Demographics
NPI:1629221486
Name:SHAPPEE, LEA RUSSELL (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:RUSSELL
Last Name:SHAPPEE
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD/LD/N
Mailing Address - Street 1:10851 MANGROVE CAY LN NE
Mailing Address - Street 2:UNIT 912
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-4212
Mailing Address - Country:US
Mailing Address - Phone:727-822-6633
Mailing Address - Fax:727-822-6616
Practice Address - Street 1:10851 MANGROVE CAY LN NE
Practice Address - Street 2:UNIT 912
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-4212
Practice Address - Country:US
Practice Address - Phone:727-822-6633
Practice Address - Fax:727-822-6616
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5398133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered