Provider Demographics
NPI:1922496173
Name:WILKINS, SHELLEY BOLT (RD)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:BOLT
Last Name:WILKINS
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 1:23 SUNNYBROOK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1855
Mailing Address - Country:US
Mailing Address - Phone:919-234-6435
Mailing Address - Fax:919-231-0314
Practice Address - Street 1:23 SUNNYBROOK RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1855
Practice Address - Country:US
Practice Address - Phone:919-234-6435
Practice Address - Fax:919-231-0314
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC962233133VN1004X
NCL002674133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric