Provider Demographics
NPI:1821749854
Name:SHIU, STEPHANIE C (MPH, RD, LD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:SHIU
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-1707
Mailing Address - Country:US
Mailing Address - Phone:541-271-2119
Mailing Address - Fax:541-271-9338
Practice Address - Street 1:385 RANCH RD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1707
Practice Address - Country:US
Practice Address - Phone:541-271-2119
Practice Address - Fax:541-271-9338
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10198119133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered