Provider Demographics
NPI:1609050194
Name:GORDON, SHERRY LYNN (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LYNN
Last Name:GORDON
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14600 SHERMAN WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-756-2577
Mailing Address - Fax:818-904-0479
Practice Address - Street 1:14600 SHERMAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2272
Practice Address - Country:US
Practice Address - Phone:818-756-2577
Practice Address - Fax:818-904-0479
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545592133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered