Provider Demographics
NPI:1851968150
Name:RUFFALO, SHELBY MARIE BURKE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE BURKE
Last Name:RUFFALO
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 CULLEN BLVD APT 1106
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5070
Mailing Address - Country:US
Mailing Address - Phone:331-262-9062
Mailing Address - Fax:
Practice Address - Street 1:1555 CULLEN BLVD APT 1106
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5070
Practice Address - Country:US
Practice Address - Phone:331-262-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85447133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered