Provider Demographics
NPI:1265658645
Name:GRAY, SHERYL (MSRDLD)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSRDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MILWAUKEE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3513
Mailing Address - Country:US
Mailing Address - Phone:847-975-9123
Mailing Address - Fax:847-478-9988
Practice Address - Street 1:1020 MILWAUKEE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3513
Practice Address - Country:US
Practice Address - Phone:847-975-9123
Practice Address - Fax:847-478-9988
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164000775133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education