Provider Demographics
NPI:1639669468
Name:ODELL, SHERRI HAYNES (RD)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:HAYNES
Last Name:ODELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GAGARIN PL
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-2737
Mailing Address - Country:US
Mailing Address - Phone:860-480-2268
Mailing Address - Fax:
Practice Address - Street 1:6 GAGARIN PL
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-2737
Practice Address - Country:US
Practice Address - Phone:860-480-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86038079133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered