Provider Demographics
NPI:1659817070
Name:SHENBERGER, DIANE (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SHENBERGER
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 LISSARA LODGE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9834
Mailing Address - Country:US
Mailing Address - Phone:336-488-9758
Mailing Address - Fax:336-860-1655
Practice Address - Street 1:626 LISSARA LODGE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9834
Practice Address - Country:US
Practice Address - Phone:717-798-5091
Practice Address - Fax:336-860-1655
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005711133V00000X
716387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered