Provider Demographics
NPI:1366810012
Name:SHEVLIN, FAITH
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:SHEVLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 CONNER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4306
Mailing Address - Country:US
Mailing Address - Phone:781-820-0917
Mailing Address - Fax:
Practice Address - Street 1:4620 ALVARADO CANYON RD
Practice Address - Street 2:STE 14
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4320
Practice Address - Country:US
Practice Address - Phone:619-229-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA957276133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered