Provider Demographics
NPI:1366632630
Name:HARRIS, CHERYL INY (MPH, RD)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:INY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 KARMICH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1622
Mailing Address - Country:US
Mailing Address - Phone:571-271-8742
Mailing Address - Fax:
Practice Address - Street 1:9675 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3762
Practice Address - Country:US
Practice Address - Phone:571-271-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA913737133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered