Provider Demographics
NPI:1780050328
Name:ROBERTSON, SHAY (RD)
Entity type:Individual
Prefix:
First Name:SHAY
Middle Name:
Last Name:ROBERTSON
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:SCHOOL OF HEALTH PROFESSIONS SUITE 2.202
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1124
Mailing Address - Country:US
Mailing Address - Phone:409-747-1633
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:SCHOOL OF HEALTH PROFESSIONS SUITE 2.202
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1124
Practice Address - Country:US
Practice Address - Phone:409-747-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81227133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric