Provider Demographics
NPI:1902205370
Name:SHELDON, KATHLEEN (RD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SHELDON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1854
Mailing Address - Country:US
Mailing Address - Phone:708-250-5643
Mailing Address - Fax:
Practice Address - Street 1:5332 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1854
Practice Address - Country:US
Practice Address - Phone:708-250-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164001006133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric