Provider Demographics
NPI:1730965146
Name:SHAPPLEY, STACY (RD, LD, CSO)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SHAPPLEY
Suffix:
Gender:F
Credentials:RD, LD, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 LILYFORD LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6267
Mailing Address - Country:US
Mailing Address - Phone:469-261-0129
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
885129133V00000X, 133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
885129OtherCDR - DIETETIC REGISTRATION
NCL004809OtherNORTH CAROLINA BOARD OF DIETETICS/NUTRITION