Provider Demographics
NPI:1265979439
Name:SHEHADEH, ISABEL
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:SHEHADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A9 CALLE 1
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-3122
Mailing Address - Country:US
Mailing Address - Phone:787-625-2500
Mailing Address - Fax:
Practice Address - Street 1:A9 CALLE 1
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-3122
Practice Address - Country:US
Practice Address - Phone:787-625-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1845133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist