Provider Demographics
NPI:1629676499
Name:BARNHART, SHELLEY LEA (RDN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LEA
Last Name:BARNHART
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24315 SE 196TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8975
Mailing Address - Country:US
Mailing Address - Phone:425-208-5018
Mailing Address - Fax:
Practice Address - Street 1:24315 SE 196TH ST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8975
Practice Address - Country:US
Practice Address - Phone:425-208-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered