Provider Demographics
NPI:1932359635
Name:ELLIOTT, SHAINA CELESTE (RD)
Entity Type:Individual
Prefix:MS
First Name:SHAINA
Middle Name:CELESTE
Last Name:ELLIOTT
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 1:124 JERRY ROAD
Mailing Address - Street 2:P.O. BOX 287
Mailing Address - City:LACASSINE
Mailing Address - State:LA
Mailing Address - Zip Code:70650
Mailing Address - Country:US
Mailing Address - Phone:337-588-4941
Mailing Address - Fax:337-588-4941
Practice Address - Street 1:1801 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8900
Practice Address - Country:US
Practice Address - Phone:337-494-6425
Practice Address - Fax:337-430-6959
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered