Provider Demographics
NPI:1457790156
Name:WOLFE-PAYTON, SHANTI A (RD)
Entity type:Individual
Prefix:
First Name:SHANTI
Middle Name:A
Last Name:WOLFE-PAYTON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 SPRING BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8093
Mailing Address - Country:US
Mailing Address - Phone:775-223-5104
Mailing Address - Fax:
Practice Address - Street 1:1861 SPRING BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8093
Practice Address - Country:US
Practice Address - Phone:775-223-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1043031133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered