Provider Demographics
NPI:1639233695
Name:SALERNO-SHORTT, MICHELLE A (RD,LDN,CDE)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:A
Last Name:SALERNO-SHORTT
Suffix:
Gender:F
Credentials:RD,LDN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:630-435-6137
Mailing Address - Fax:630-963-1524
Practice Address - Street 1:3743 HIGHLAND AVE STE 1001
Practice Address - Street 2:DUPAGE MEDICAL GROUP
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1594
Practice Address - Country:US
Practice Address - Phone:630-435-6137
Practice Address - Fax:630-963-1524
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
205120Medicare ID - Type Unspecified
ILR00019Medicare PIN