Provider Demographics
NPI:1780329375
Name:GRANDE, SHELBY ELIZABETH (RD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:GRANDE
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 1:4401 4TH ST N APT 428
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-3065
Mailing Address - Country:US
Mailing Address - Phone:443-481-8765
Mailing Address - Fax:
Practice Address - Street 1:3335 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5219
Practice Address - Country:US
Practice Address - Phone:703-522-2722
Practice Address - Fax:703-564-8567
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty