Provider Demographics
NPI:1558552935
Name:PHILLIPS, CHERYL J (RD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:J
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:424 E98TH. STREET, SUITE 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212
Mailing Address - Country:US
Mailing Address - Phone:718-922-2050
Mailing Address - Fax:718-922-2050
Practice Address - Street 1:424 EAST 98TH. STREET, SUITE 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-922-2050
Practice Address - Fax:718-922-2050
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006351-1133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic