Provider Demographics
NPI:1659657997
Name:RUEBSAHM, SHANA LYNNE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:LYNNE
Last Name:RUEBSAHM
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1295
Mailing Address - Country:US
Mailing Address - Phone:210-464-6063
Mailing Address - Fax:
Practice Address - Street 1:7180 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1295
Practice Address - Country:US
Practice Address - Phone:210-464-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered