Provider Demographics
NPI:1649808361
Name:VOELTZ, SHELBY LYNN (RD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:VOELTZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 BENJAMIN ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2325
Mailing Address - Country:US
Mailing Address - Phone:612-720-5327
Mailing Address - Fax:
Practice Address - Street 1:347 SMITH AVE N STE 404
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3354
Practice Address - Country:US
Practice Address - Phone:651-220-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3959133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered