Provider Demographics
NPI:1326402983
Name:IODICE, SHERYL R (RD, LDN)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:R
Last Name:IODICE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:LANESBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01237-0635
Mailing Address - Country:US
Mailing Address - Phone:413-442-6574
Mailing Address - Fax:
Practice Address - Street 1:1100 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LANESBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01237
Practice Address - Country:US
Practice Address - Phone:413-442-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2972133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered