Provider Demographics
NPI:1659496271
Name:SHEEKS, ELIZABETH EDWARDS (RD, MS, LDN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EDWARDS
Last Name:SHEEKS
Suffix:
Gender:F
Credentials:RD, MS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4615
Mailing Address - Country:US
Mailing Address - Phone:704-450-7711
Mailing Address - Fax:
Practice Address - Street 1:3411 GRAYSTONE PL SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8200
Practice Address - Country:US
Practice Address - Phone:828-328-1118
Practice Address - Fax:828-328-1119
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000958133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric