Provider Demographics
NPI:1558928887
Name:JENKO, SHERRY ANN (NDTR)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:JENKO
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:ANN
Other - Last Name:JENKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NDTR
Mailing Address - Street 1:2500 METROHEALTH DR # R229
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-7433
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH86008858OtherCOMMISSION OF DIETETIC REGISTRATION, NUTRITIONIST DIETETIC TECHNICIAN REGISTERED