1538580386 NPI number — MARY BETH SHEFFIELD MS, RDN, LD

Table of content: MARY BETH SHEFFIELD MS, RDN, LD (NPI 1538580386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538580386 NPI number — MARY BETH SHEFFIELD MS, RDN, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEFFIELD
Provider First Name:
MARY
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538580386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 CR 995
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IUKA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-279-0984
Provider Business Mailing Address Fax Number:
662-424-0308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 CR 995
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IUKA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-279-0984
Provider Business Practice Location Address Fax Number:
662-424-0308
Provider Enumeration Date:
12/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  D1368 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133V00000X , with the licence number: 2300 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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