Provider Demographics
NPI:1982589479
Name:SHELTON, VIRGINIA KATHLEEN (RDN, LD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:KATHLEEN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:KATHLEEN
Other - Last Name:KOMATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:5001 PONY CHASE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6720
Mailing Address - Country:US
Mailing Address - Phone:512-576-8442
Mailing Address - Fax:
Practice Address - Street 1:5001 PONY CHASE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-6720
Practice Address - Country:US
Practice Address - Phone:512-576-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT92378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered