Provider Demographics
NPI:1750513891
Name:RODRIGUEZ, SHEILA (LND)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:T5 CALLE REINA DE LAS FLORES
Mailing Address - Street 2:URB. SANTA CLARA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6817
Mailing Address - Country:US
Mailing Address - Phone:787-384-5947
Mailing Address - Fax:
Practice Address - Street 1:1728 CALLE SEGRE
Practice Address - Street 2:RIO PIEDRAS HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3257
Practice Address - Country:US
Practice Address - Phone:787-384-5947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1529133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist