Provider Demographics
NPI:1316371206
Name:LIN, SHERRY (MFA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MFA, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BRIDEWELL ST APT 246
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3788
Mailing Address - Country:US
Mailing Address - Phone:630-310-6885
Mailing Address - Fax:
Practice Address - Street 1:1602 DURHAM CT APT D
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5908
Practice Address - Country:US
Practice Address - Phone:630-310-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164.005966OtherLICENSE #