Provider Demographics
NPI:1447844873
Name:SHELTON, CHRISTY KAY (MS,RS)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:KAY
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MS,RS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 SE BURNING LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7532
Mailing Address - Country:US
Mailing Address - Phone:904-860-4400
Mailing Address - Fax:
Practice Address - Street 1:900 SE SALERNO RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6405
Practice Address - Country:US
Practice Address - Phone:772-223-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5547133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered