Provider Demographics
NPI:1134341480
Name:SMILEY, SHANNON STEELE (RD)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:STEELE
Last Name:SMILEY
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 1:1721 E 19TH AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1251
Mailing Address - Country:US
Mailing Address - Phone:303-861-4505
Mailing Address - Fax:303-861-9036
Practice Address - Street 1:1721 E 19TH AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1251
Practice Address - Country:US
Practice Address - Phone:303-861-4505
Practice Address - Fax:303-861-9036
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered