Provider Demographics
NPI:1669356051
Name:SHEALY, LUKE REISER (RD)
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:REISER
Last Name:SHEALY
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 S OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1176
Mailing Address - Country:US
Mailing Address - Phone:406-438-3609
Mailing Address - Fax:
Practice Address - Street 1:2103 S OAKLAND ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1176
Practice Address - Country:US
Practice Address - Phone:406-438-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86093784133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered