Provider Demographics
NPI:1184471468
Name:SHAUGNESSY, KELSEY CONYERS (RD, RDN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CONYERS
Last Name:SHAUGNESSY
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 FAIRWAY DR SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3418
Mailing Address - Country:US
Mailing Address - Phone:804-363-1203
Mailing Address - Fax:
Practice Address - Street 1:2316 FAIRWAY DR SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3418
Practice Address - Country:US
Practice Address - Phone:804-363-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86071636133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered