Provider Demographics
NPI:1770128704
Name:MILLER, SHONDA (MS)
Entity type:Individual
Prefix:MS
First Name:SHONDA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 GREENHILL DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-4428
Mailing Address - Country:US
Mailing Address - Phone:256-268-4444
Mailing Address - Fax:
Practice Address - Street 1:819 COOK AVE NW STE 106
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5983
Practice Address - Country:US
Practice Address - Phone:256-426-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YS0200X, 133NN1002X
133VN1201X, 172V00000X, 372600000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No172V00000XOther Service ProvidersCommunity Health Worker
No372600000XNursing Service Related ProvidersAdult Companion
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program