Provider Demographics
NPI:1033202841
Name:PHILLIPS, SHERYL E (MPH; RD, CDE, CDN)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:E
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MPH; RD, CDE, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 VETERANS HWY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2329
Mailing Address - Country:US
Mailing Address - Phone:631-650-7580
Mailing Address - Fax:631-650-7581
Practice Address - Street 1:740 VETERANS HWY
Practice Address - Street 2:SUITE 306
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2329
Practice Address - Country:US
Practice Address - Phone:631-650-7580
Practice Address - Fax:631-650-7581
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001992133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011992OtherNYS LICENSE