Provider Demographics
NPI:1821344979
Name:PITTS, SHALANE MARIE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:SHALANE
Middle Name:MARIE
Last Name:PITTS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-3607
Mailing Address - Country:US
Mailing Address - Phone:318-359-0595
Mailing Address - Fax:318-487-5338
Practice Address - Street 1:5604B COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3709
Practice Address - Country:US
Practice Address - Phone:318-487-5260
Practice Address - Fax:318-487-5338
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
132700000X, 133N00000X, 133NN1002X, 133V00000X
LA581133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education