Provider Demographics
NPI:1154465284
Name:SHOCKEY, CHERYL LYNN (RD, MS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:SHOCKEY
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BROKAW PL
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5631
Mailing Address - Country:US
Mailing Address - Phone:920-738-5356
Mailing Address - Fax:
Practice Address - Street 1:APPLETON MEDICAL CENTER 1818 NORTH MEADE STREET
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-738-5356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI420029133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic