Provider Demographics
NPI:1871979328
Name:BLAKENEY, SHELLEY (RDN, LD, CNSC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BLAKENEY
Suffix:
Gender:F
Credentials:RDN, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8553 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8295
Mailing Address - Country:US
Mailing Address - Phone:972-338-5489
Mailing Address - Fax:
Practice Address - Street 1:8553 DAVIS DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8295
Practice Address - Country:US
Practice Address - Phone:972-338-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81052133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric