Provider Demographics
NPI:1417141557
Name:HAWKS, SHARON EVETTE (MS, RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:EVETTE
Last Name:HAWKS
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 ANNAPOLIS RD
Mailing Address - Street 2:STE 104
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:301-805-8292
Mailing Address - Fax:301-352-0405
Practice Address - Street 1:12150 ANNAPOLIS RD.
Practice Address - Street 2:STE. 104
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769
Practice Address - Country:US
Practice Address - Phone:301-805-8292
Practice Address - Fax:301-352-0405
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01715133NN1002X, 133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD471398OtherUNITED HEALTHCARE
MDKFR3NUOtherBLUECROSS BLUESHIELD
DCJ0940001OtherBLUECROSS BLUESHIELD
MD7321187OtherAETNA
MD3205532OtherAETNA