Provider Demographics
NPI:1255146783
Name:SHELTON, ALYSSA LYNN (RD, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LYNN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LYNN
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, IBCLC
Mailing Address - Street 1:5213 N CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1665
Mailing Address - Country:US
Mailing Address - Phone:614-561-3996
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0134663133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered