Provider Demographics
NPI:1679328488
Name:SHAH, SHRUTI (RDN)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:SHAH
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 1:1325 HIGHPOINT CT
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1732
Mailing Address - Country:US
Mailing Address - Phone:630-830-8412
Mailing Address - Fax:
Practice Address - Street 1:1325 HIGHPOINT CT
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-1732
Practice Address - Country:US
Practice Address - Phone:630-830-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered