Provider Demographics
NPI:1578870804
Name:FREY LUDWIG, SHERRI (MSRD)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:FREY LUDWIG
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 ADAGIO DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-4112
Mailing Address - Country:US
Mailing Address - Phone:707-410-6238
Mailing Address - Fax:707-207-0125
Practice Address - Street 1:710 ADAGIO DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-4112
Practice Address - Country:US
Practice Address - Phone:707-410-6238
Practice Address - Fax:707-207-0125
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS727731133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal