Provider Demographics
NPI:1164889077
Name:BARKE, SHERI (MPH, RD, CSSD)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:BARKE
Suffix:
Gender:F
Credentials:MPH, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25734 WORDSWORTH LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1302
Mailing Address - Country:US
Mailing Address - Phone:661-886-2720
Mailing Address - Fax:661-799-9846
Practice Address - Street 1:25129 THE OLD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-2244
Practice Address - Country:US
Practice Address - Phone:661-886-2720
Practice Address - Fax:661-799-9846
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA808498133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered