Provider Demographics
NPI:1184245961
Name:SHAFFER, CHELSEA ELIZABETH (RDN, LD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ELIZABETH
Last Name:SHAFFER
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 1:22320 RILEY RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46536-9433
Mailing Address - Country:US
Mailing Address - Phone:574-344-9499
Mailing Address - Fax:
Practice Address - Street 1:22320 RILEY RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:IN
Practice Address - Zip Code:46536-9433
Practice Address - Country:US
Practice Address - Phone:574-344-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-02
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86105286133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered